Age-related macular degeneration 1969-2004: A 35-year personal perspective

PURPOSE: To provide a personal perspective concerning diagnosis, treatment, and evaluation of treatment for early and late stages of age-related macular degeneration (AMD) over a 35 year period, 1969-2004. DESIGN: Literature review, personal recollections, and conversations with investigators who participated in trials to evaluate treatments for AMD. METHODS: The author reviewed the literature pertaining to evaluation and treatment of patients with AMD and conversed with investigators who, over the past 35 years, designed, conducted and participated in trials to assess new and existing treatments for AMD. RESULTS: In 1969, patients with AMD constituted a small part of a typical ophthalmic practice. From 1969 to 2004, the prevalence of AMD has increased, and the methods of evaluation and treatment have changed dramatically. The emergence of fluorescein angiography and the development of laser photocoagulation and photodynamic therapy have substantially altered clinical practice. Several promising pharmacologic interventions are now being assessed in clinical trials. Nevertheless, AMD remains the leading cause of severe and irreversible vision loss in the United States because there are no highly effective treatments available for most patients. CONCLUSIONS: Because of an aging population and the lack of highly effective treatments, late AMD remains a major unsolved problem. However, there is extensive research being conducted with support from the National Eye Institute and from industry. There is also great interest in prevention trials. Accordingly, the author is optimistic that over the next 35 years there will be significant improvements in our ability to prevent severe vision loss from late AMD. (c) 2005 by Elsevier Inc. All rights reserved.