CHANGES IN BRUCHS MEMBRANE AND RELATED STRUCTURES WITH AGE

Agr-related macular disease is a major and growing public health burde n in developed Cancasian societies, accounting for about 50% of blind registration. Evidence exists that this is an emerging problem in East ern Asia, although the phenotype appears to differ From that seen in W estern society. It is likely that several genes are involved, and that the genes or allelic variants conferring are common. Environment play s a major role in its pathogenesis, and ii is believed that generic su sceptibility becomes apparent only if there are sufficient environment al pressures. There is no therapy currently available that will have a n impact on the prevalence of blindness from age-related macular disea se. It has been shown that visual loss occurs as a reaction to ageing changes in Bruch's membrane, which is interposed between the choriocap illaris and the retinal pigment epithelium. The age changes in all thr ee structures have been partly characterised, and as a consequence, mu ltiple putative pathogenic mechanisms have been proposed. Cross-sectio nal studies of populations with different genetic background and life styles would serve to prove the importance of inheritance and environm ent. Molecular genetic analysis of blood from affected sibling pairs f rom these sources may indicate the relevant genes, the prevalence or w hich may differ in different communities. Enquiries as to life styles may determine important environmental influences. Examination of donor eyes from these communities may reveal distinctive features that may reflect the variation in genetic predisposition and environmental pres sures. It is hoped that the findings from such studies will lead to no vel and potentially successful management strategies. (C) 1998 Publish ed by Elsevier Science Ltd. AII rights reserved.