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      Early Detection, Diagnosis and Management of Choroidal Neovascularization in Age-Related Macular Degeneration: The Role of Ophthalmologists


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          Choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) is a serious condition which, if unrecognized and untreated, can result in the rapid deterioration of vision. Early detection and prompt referral to a retina specialist may potentially reduce the high risk of severe vision loss. The majority of AMD patients with CNV who present to an ophthalmologist will have been referred by either a primary care physician or an optometrist. Following referral, ophthalmologists will confirm diagnosis and identify the location and composition of the CNV. This information will provide the basis for a decision on what treatment, if any, is indicated. Until last year, laser photocoagulation was the only clinically-proven treatment option for neovascular AMD in large-scale randomized clinical trials, although many patients were not eligible for this treatment. Verteporfin (Visudyne<sup>TM</sup>) therapy is a new treatment option that uses photodynamic therapy in patients with predominantly classic subfoveal CNV secondary to AMD. Retrospective analyses show that the introduction of verteporfin therapy is likely to increase the number of patients with neovascular AMD who can be treated. Early detection, prompt referral and treatment, together with appropriate use of low vision aids, will help to optimize patient outcomes and quality of life.

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          Iris color, skin sun sensitivity, and age-related maculopathy. The Blue Mountains Eye Study.

          The purpose of the study was to assess relationships between age-related maculopathy (ARM) and iris color, skin sun sensitivity, and other sunlight-related factors. Cross-sectional population-based study. The Blue Mountains Eye Study performed a detailed eye examination of 3654 residents living in the Blue Mountains area, west of Sydney, Australia. Subjects with late age-related macular degeneration (late AMD), early ARM, and large drusen (> or = 125 microns diameter) were identified using masked grading of retinal photographs. Iris color was graded using standard photographs, and interviewers collected questionnaire data on sunlight-related factors. Logistic regression, adjusting for age, sex, AMD family history, and current smoking, was used to assess associations. Blue iris color was significantly associated with an increased risk of both late AMD (odds ratio [OR], 1.69) and early ARM (OR, 1.45). An increased risk of late AMD, but not early ARM, was associated with both high (OR, 2.54) and low (OR, 2.18) skin sun sensitivity, as assessed using the Fitzpatrick sun-sensitivity scale. These associations remained after adjusting for the presence of sun-related skin damage. Neither history (or treatment) of skin cancer lesions, signs of sun-induced skin damage, or number of severe sunburns was associated with either late AMD or early ARM. Blue iris color was associated with an increased risk of both late AMD and early ARM in this population. Abnormal skin sensitivity to sunlight was also associated with an increased risk of late AMD.

            Author and article information

            S. Karger AG
            August 2001
            31 May 2001
            : 215
            : 4
            : 247-253
            Hôpital Ophtalmique Universitaire Jules Gonin, Lausanne, Switzerland
            50869 Ophthalmologica 2001;215:247–253
            © 2001 S. Karger AG, Basel

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            Page count
            Figures: 2, References: 41, Pages: 7
            Review · Revue · Übersichtsarbeit

            Vision sciences,Ophthalmology & Optometry,Pathology
            Verteporfin,Age-related macular degeneration,Choroidal neovascularization,Photodynamic therapy,VisudyneTM


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