PREVENTATIVE OPHTHALMOLOGY - AGE-RELATED MACULAR DEGENERATION

Purpose: This report was designed to review the current knowledge abou t preventing the development or progression of age-related macular deg eneration (AMD) and visual loss associated with this entity in practic al terms for the comprehensive ophthalmologist. Methods: Animal studie s, epidemiologic studies, and clinical trials identified through the u se of MEDLINE, a reference list of articles reviewed, and personal con tact with experts in this area provided information reviewed for this report. Results: Reports concerning ultraviolet and visible light prov ide limited, inconsistent, and conflicting data to support the theory that light exposure leads to AMD. Micronutrient supplementation is a p rovocative but largely unproven hypothesis. Positive associations of c igarette smoking and cardiovascular disease or certain risk factors fo r cardiovascular disease with AMD provide potential clues as to the un derlying pathogenesis of AMD and are yet another reason to treat these health problems. Drusen may disappear after laser to the macula; howe ver, this intervention will require careful, randomized, prospective t rials to determine if this therapy can reduce the risk of choroidal ne ovascularization and visual loss developing in patients with AMD. Conc lusions: It is reasonable to have individuals wear sunglasses for comf ort and possible protection from ultraviolet light exposure to all ocu lar structures (especially the lens) at little or no risk to the patie nt. Physicians probably should be reluctant to prescribe micronutrient s or suggest other interventions (such as laser to drusen) until their health claims have been substantiated and their long-term safety soun dly established.