Age related macular degeneration

Age related macular degeneration, as the term implies, affects older adults and accounts for about half of all vision impairment or blind registrations in the developed world.1 Its prevalence is increasing with the demographic shift towards an ageing society. Recent evidence from large scale population based epidemiological studies confirms that it is also a major cause of sight loss in the developing world, in countries such as India,2 where life expectancy continues to rise. The two vision threatening manifestations of age related macular degeneration occur either as a consequence of neovascularisation, which causes an acute exudative pathology, or from cell loss due to geographic atrophy. Both neovascular age related macular degeneration and geographic atrophy result in reduced central vision with inability to undertake tasks that require visual discrimination, such as reading, driving, and recognising faces. The main aims of treatment are either to prevent the progression of early features to the late stage manifestations or to treat the symptoms of advanced disease if these do occur. Currently, intravitreal treatment with humanised monoclonal antibodies against vascular endothelial growth factor is used to ameliorate the acute manifestations of neovascular age related macular degeneration. This review examines the pathogenesis of age related macular degeneration and recent advances in its management.