Preface

Management of the patient affected by age-related macular degeneration (AMD) represents a para‐ digm challenge. Research has yielded major discoveries about the etiology, pathophysiology, and treatment of AMD over the last decade, although more steps are needed to continue to improve our know-how. The purpose of *"Age-related Macular Degeneration - Etiology, Diagnosis and Manage‐ ment - A Glance at the Future"* is to provide up-to-date information of the pathophysiology, diagno‐ sis, management, and treatment of age-related macular degeneration. In this volume I have attempted to collect a significant amount of new information from retinal experts to first summa‐ rize the established information and then to present the most novel developments in their respec‐ tive fields. The first section of this book includes the pathophysiology and epidemiology, of agerelated macular degeneration. Oxidative damage to the RPE, extracellular matrix turnover, inflammation, and angiogenesis appear to be key cellular processes that play a central role in the pathogenesis of AMD. Some chapters will focus on the pathobiology of early stage AMD and its evolution to the later form also exploring the role of injury at the RPE in the onset and develop‐ ment of the disease. The second section focuses on the clinical features and diagnosis of age-related macular degeneration. The clinical findings seen in the nonexudative and exudative forms are dis‐ cussed. The section on imaging includes a chapter on new OCT technology including: Swept Source OCT (SS-OCT), Enhanced Depth Imaging OCT (EDI-OCT), and adaptive optics. A variety of emerging OCT technologies are poised to expand significantly the scope of OCT imaging and to enhance significantly our approach to the diagnosis and management of patients with retinal dis‐ ease. An in-depth understanding of these technologies and their potential advantages and disad‐ vantages will aid retinal specialists in utilizing these new methods optimally. The next and last section reports information on current and experimental forms of treatment for non-exudative and exudative forms of age-related macular degeneration.

The advent of intravitreal anti-VEGF therapy (targeting all isoforms) dramatically altered the standard of care and treatment paradigms for patients with NVAMD. However, In spite of this significant step forward in the treatment of NVAMD, significant challenges remain. The presenta‐ tion of the treatment options includes a discussion of the mechanism of action, the clinical treat‐ ment technique, the targeted patient population, as well as the expected outcomes of each treatment. No single manageable volume can analyze all of the existing knowledge concerning a disease such as age-related macular degeneration. Special attention has been paid to making the text easily readable. My sincere hope is that readers will find as much pleasure reading this text‐ book as I have had writing and editing it.

> **Dr. Giuseppe Lo Giudice** San Paolo Ophthalimc Center, San Antonio Hospital, Italy

> > *To my father*

**Section 1**

**Epidemiology and Risk Factors**

**Epidemiology and Risk Factors**

**Chapter 1**

**AMD: Epidemiology and Risk Factors**

Age-related maculopathy (ARM) and age-related macular degeneration (AMD) are stages in a process of degeneration of the central macular region of the retina defined as occurring over the age of 50. This chapter examines the evidence for environmental and genetic risk factors

Incidence rates for all ARM lesions increases significantly with age. In the Blue Mountains Eye Study (BMES) Mitchell et al found overall 5-year incidence of late ARM lesions (combined geographic atrophy and neovascular ARM), was 1.1%. Age specific rates were 0.0%, 0.6%, 2.4%, and 5.4% for participants aged 60 years and younger, 60 to 69 years, 70 to 79 years, and 80 years and older at baseline, respectively [1]. After excluding participants with either early or late ARM in either eye at baseline, the overall 5-year incidence of early ARM was 8.7%, (3.2%, 7.4%, 18.3%, and 14.8% for the corresponding age. The findings parallel those in the Beaver Dam Eye Study (BDES) where it was noted those 75 years of age or older have significantly higher 5-year incidence of exudative macular degeneration (1.8% vs. 0%), and

Individual ARM fundus signs that predict best the development of AMD are large drusen (> or =125 microm) [3], 10% or more of the grid area covered by drusen [3], soft indistinct drusen [2] and focal hyperpigmentation [2;4]. There is a high risk of second eye involvement with

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© 2013 Khan; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

© 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution,

distribution, and reproduction in any medium, provided the original work is properly cited.

pure geographic atrophy (1.7% vs. 0%) than people 43 to 54 years of age [2].

Additional information is available at the end of the chapter

Jane Khan

**1. Introduction**

for developing AMD.

**2. Epidemiology**

*2.1.1. Incidence*

**2.1. Burden and impact of disease**

http://dx.doi.org/10.5772/55234
