Survey of Ophthalmology
Volume 48, Issue 3 , Pages 257-293, May 2003

Age-Related Macular Degeneration: Etiology, Pathogenesis, and Therapeutic Strategies☆

  • Jayakrishna Ambati, MD

      Affiliations

    • Ocular Angiogenesis Laboratory, Department of Ophthalmology, University of Kentucky, Lexington, KY USA
    • Massachusetts Eye&Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA USA
    • ,
  • Balamurali K Ambati, MD

      Affiliations

    • Massachusetts Eye&Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA USA
    • Department of Ophthalmology, Medical College of Georgia, Augusta, GA USA
    • ,
  • Sonia H Yoo, MD

      Affiliations

    • Massachusetts Eye&Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA USA
    • Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, FL USA
    • ,
  • Sean Ianchulev, MD

      Affiliations

    • Massachusetts Eye&Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA USA
    • ,
  • Anthony P Adamis, MD

      Affiliations

    • Massachusetts Eye&Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA USA
    • Children's Hospital, Harvard Medical School, Boston, MA USA
    • Eyetech Research Center, Woburn, MA, USA
    • Corresponding Author InformationReprint address: Anthony P. Adamis, MD, Eyetech Research and Development Center, 42 Cummings Park, Woburn, MA 01801. Dr. Adamis is an employee of Eyetech Pharmaceuticals

Abstract 

Age-related macular degeneration is the principal cause of registered legal blindness among those aged over 65 in the United States, western Europe, Australia, and Japan. Despite intensive research, the precise etiology of molecular events that underlie age-related macular degeneration is poorly understood. However, investigations on parallel fronts are addressing this prevalent public health problem. Sophisticated biochemical and biophysical techniques have refined our understanding of the pathobiology of drusen, geographic atrophy, and retinal pigment epithelial detachments. Epidemiological identification of risk factors has facilitated an intelligent search for underlying mechanisms and fueled clinical investigation of behavior modification. Gene searches have not only brought us to the cusp of identifying the culpable gene loci in age-related macular degeneration, but also localized genes responsible for other macular dystrophies. Recent and ongoing investigations, often cued by tumor biology, have revealed an important role for various growth factors, particularly in the neovascular form of the condition. Transgenic and knockout studies have provided important mechanistic insights into the development of choroidal neovascularization, the principal cause of vision loss in age-related macular degeneration. This in turn has culminated in preclinical and clinical trials of directed molecular interventions.

Keywords:  age-related macular degeneration, choroidal neovascularization, drusen, macular dystrophies

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☆ Supported, in part, by a Foundation Fighting Blindness Career Development Award (JA), Heed Ophthalmic Foundation (JA, BKA), AOS-Knapp Testimonial Fund (JA), University of Kentucky Physician Scientist Award (JA), Prevent Blindness America/Fight for Sight Grant-in-Aid (JA), National Eye Institute (APA), Massachusetts Lions Research Fund (APA), Falk Foundation (APA), Iaccoca Foundation (APA), and the Roberta Siegel Fund (APA). The authors reported no proprietary or commercial interest in any product mentioned or concept discussed in this article.

PII: S0039-6257(03)00030-4

doi:10.1016/S0039-6257(03)00030-4

Survey of Ophthalmology
Volume 48, Issue 3 , Pages 257-293, May 2003

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