Nonexudative ARMD Medication

  • Author: Raj K Maturi, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Jul 22, 2011
 
 

Medication Summary

Currently, no approved drug treatment of dry age-related macular degeneration (ARMD) is available. See Surgical Care for the possible beneficial effects of laser therapy.

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Contributor Information and Disclosures
Author

Raj K Maturi, MD  Clinical Associate Professor, Volunteer, Department of Ophthalmology, Indiana University School of Medicine; Retina Service, Midwest Eye Institute, Indianapolis, IN

Raj K Maturi, MD is a member of the following medical societies: American Academy of Ophthalmology and American Society of Retina Specialists

Disclosure: Eli Lilly Consulting fee Consulting; Allergan Grant/research funds Consulting; DRCR/National Eye Institute, NIH Consulting fee Consulting; Pfizer, Inc. Grant/research funds Consulting; LUX, Inc Grant/research funds Consulting; Novalgali Grant/research funds Consulting; DRCR/JAEB None

Specialty Editor Board

Brian A Phillpotts, MD  Former Vitreo-Retinal Service Director, Former Program Director, Clinical Assistant Professor, Department of Ophthalmology, Howard University College of Medicine

Brian A Phillpotts, MD is a member of the following medical societies: American Academy of Ophthalmology, American Diabetes Association, American Medical Association, and National Medical Association

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Steve Charles, MD  Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine; Adjunct Professor of Ophthalmology, Columbia College of Physicians and Surgeons; Clinical Professor Ophthalmology, Chinese University of Hong Kong

Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Club Jules Gonin, Macula Society, and Retina Society

Disclosure: Alcon Laboratories Consulting fee Consulting; OptiMedica Ownership interest Other; Topcon Medical Lasers Consulting fee Consulting

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

  1. Christen WG, Glynn RJ, Chew EY, Albert CM, Manson JE. Folic acaid, pyridoxine, and cyanocobalamin combination treatment and age-related macular degeneration in women: the Women's Antioxidant and Folic Acid Cardiovasacular Study. Arch intern Med. Feb 2009;169(4):335-41.

  2. [Best Evidence] [Guideline] Ferris FL, Davis MD, Clemons TE, et al. A simplified severity scale for age-related macular degeneration: AREDS Report No. 18. Arch Ophthalmol. Nov 2005;123(11):1570-4. [Medline]. [Full Text].

  3. Johnson PT, Betts KE, Radeke MJ, Hageman GS, Anderson DH, Johnson LV. Individuals homozygous for the age-related macular degeneration risk-conferring variant of complement factor H have elevated levels of CRP in the choroid. Proc Natl Acad Sci U S A. Nov 14 2006;103(46):17456-61. [Medline].

  4. Maller J, George S, Purcell S, et al. Common variation in three genes, including a noncoding variant in CFH, strongly influences risk of age-related macular degeneration. Nat Genet. Sep 2006;38(9):1055-9. [Medline].

  5. SanGiovanni JP, Chew EY, Clemons TE, et al. The relationship of dietary lipid intake and age-related macular degeneration in a case-control study: AREDS Report No. 20. Arch Ophthalmol. May 2007;125(5):671-9. [Medline].

  6. Christen WG, Schaumberg DA, Glynn RJ, Buring JE. Dietary {omega}-3 Fatty Acid and Fish Intake and Incident Age-Related Macular Degeneration in Women. Arch Ophthalmol. Jul 2011;129(7):921-9. [Medline]. [Full Text].

  7. Seddon JM, George S, Rosner B. Cigarette smoking, fish consumption, omega-3 fatty acid intake, and associations with age-related macular degeneration: the US Twin Study of Age-Related Macular Degeneration. Arch Ophthalmol. Jul 2006;124(7):995-1001. [Medline].

  8. Blodi BA. Nutritional supplements in the prevention of age-related macular degeneration. Insight. Jan-Mar 2004;29(1):15-6; quiz 17-8. [Medline].

  9. Dashti N, McGwin G, Owsley C, Curcio CA. Plasma apolipoproteins and risk for age related maculopathy. Br J Ophthalmol. Aug 2006;90(8):1028-33. [Medline].

  10. Hawkins BS, Bird A, Klein R, West SK. Epidemiology of age-related macular degeneration. Mol Vis. Nov 3 1999;5:26. [Medline]. [Full Text].

  11. Millen AE, Voland R, Sondel SA, Parekh N, Horst RL, Wallace RB, et al. Vitamin D Status and Early Age-Related Macular Degeneration in Postmenopausal Women. Arch Ophthalmol. Apr 2011;129(4):481-489. [Medline]. [Full Text].

  12. McCarty CA, Dowrick A, Cameron J, et al. Novel Measure of Cardiovascular Health and its Association with Prevalence and Progression of Age-Related Macular Degeneration: The CHARM Study. BMC Ophthalmology. 2008.

  13. Klein R, Knudtson MD, Klein BE. Statin use and the five-year incidence and progression of age-related macular degeneration. Am J Ophthalmol. Jul 2007;144(1):1-6. [Medline].

  14. Eter N, Krohne TU, Holz FG. New pharmacologic approaches to therapy for age-related macular degeneration. BioDrugs. 2006;20(3):167-79. [Medline].

  15. Bartlett H, Eperjesi F. Age-related macular degeneration and nutritional supplementation: a review of randomised controlled trials. Ophthalmic Physiol Opt. Sep 2003;23(5):383-99. [Medline].

  16. Jackson ML. Vision Rehabilitation Services. Medscape Ophthalmology [serial online]. 2008;Available from: AMD Expert Column Series. Available at www.medscape.com/viewarticle/583661.

  17. Bird AC, Bressler NM, Bressler SB, et al. An international classification and grading system for age-related maculopathy and age-related macular degeneration. The International ARM Epidemiological Study Group. Surv Ophthalmol. Mar-Apr 1995;39(5):367-74. [Medline].

  18. Christen WG, Glynn RJ, Chew EY, Albert CM, Manson JE. Folic acid, pyridoxine, and cyanocobalamin combination treatment and age-related macular degeneration in women: the Women's Antioxidant and Folic Acid Cardiovascular Study. Arch Intern Med. Feb 23 2009;169(4):335-41. [Medline].

  19. Christen WG, Glynn RJ, Chew EY, Albert CM, Manson JE. Folic acid, pyridoxine, and cyanocobalamin combination treatment and age-related macular degeneration in women: the Women's Antioxidant and Folic Acid Cardiovascular Study. Arch Intern Med. Feb 23 2009;169(4):335-41. [Medline].

  20. Christen WG, Glynn RJ, Chew EY, Albert CM, Manson JE. Folic acid, pyridoxine, and cyanocobalamin combination treatment and age-related macular degeneration in women: the Women's Antioxidant and Folic Acid Cardiovascular Study. Arch Intern Med. Feb 23 2009;169(4):335-41. [Medline].

  21. Christen WG, Glynn RJ, Chew EY, Albert CM, Manson JE. Folic acid, pyridoxine, and cyanocobalamin combination treatment and age-related macular degeneration in women: the Women's Antioxidant and Folic Acid Cardiovascular Study. Arch Intern Med. Feb 23 2009;169(4):335-41. [Medline].

  22. Coleman H, Chew E. Nutritional supplementation in age-related macular degeneration. Curr Opin Ophthalmol. May 2007;18(3):220-3. [Medline].

  23. Comer GM, Ciulla TA, Criswell MH, Tolentino M. Current and future treatment options for nonexudative and exudative age-related macular degeneration. Drugs Aging. 2004;21(15):967-92. [Medline].

  24. [Best Evidence] Evans JR. Antioxidant vitamin and mineral supplements for slowing the progression of age-related macular degeneration. Cochrane Database Syst Rev. 2006;(2):CD000254. [Medline].

  25. Garibaldi DC, Zhang K. Molecular genetics of macular degeneration. Int Ophthalmol Clin. 1999;39(4):117-42. [Medline].

  26. Luibl V, Isas JM, Kayed R, Glabe CG, Langen R, Chen J. Drusen deposits associated with aging and age-related macular degeneration contain nonfibrillar amyloid oligomers. J Clin Invest. Feb 2006;116(2):378-85. [Medline].

  27. Lutty G, Grunwald J, Majji AB, Uyama M, Yoneya S. Changes in choriocapillaris and retinal pigment epithelium in age-related macular degeneration. Mol Vis. Nov 3 1999;5:35. [Medline]. [Full Text].

  28. McBee WL, Lindblad AS, Ferris FL 3rd. Who should receive oral supplement treatment for age-related macular degeneration?. Curr Opin Ophthalmol. Jun 2003;14(3):159-62. [Medline].

  29. Mitchell P, Smith W, Attebo K, Wang JJ. Prevalence of age-related maculopathy in Australia. The Blue Mountains Eye Study. Ophthalmology. Oct 1995;102(10):1450-60. [Medline].

  30. Schmidt-Erfurth U. Nutrition and retina. Dev Ophthalmol. 2005;38:120-47. [Medline].

  31. Sunness JS. The natural history of geographic atrophy, the advanced atrophic form of age-related macular degeneration. Mol Vis. Nov 3 1999;5:25. [Medline]. [Full Text].

  32. Winkler BS, Boulton ME, Gottsch JD, Sternberg P. Oxidative damage and age-related macular degeneration. Mol Vis. Nov 3 1999;5:32. [Medline]. [Full Text].

 
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A normal-appearing macula of the left eye. Note the even pigmentation of the retinal pigment epithelium and the absence of any yellow excrescences (drusen) in the fovea. The optic nerve has unrelated changes.
In angiography, fluorescein dye is passed through a peripheral vein and transmits through the vascular system. The dye fluoresces in the vasculature, as seen here. No vascular prominences are seen in the macula or in any areas of dye pooling or staining. The abnormal vessels in the optic nerve, however, do show dye leakage.
Moderate nonexudative age-related macular degeneration is shown with the presence of drusen (yellow deposits) in the macular region.
Staining of drusen. Drusen absorb dye and, in the late frames of the angiogram, show hyperfluorescence. This staining is distinguished from the leakage that occurs when the dye spreads outside the boundary of the lesion.
A more advanced case of nonexudative age-related macular degeneration (ARMD). This image shows drusen that are larger, more confluent, and soft. Soft drusen are defined as drusen that have indistinct borders. Such drusen are more likely to convert to wet ARMD. A few areas of atrophy are noted, where the retinal pigment epithelium (RPE) has lost pigmentation. The retinal cells overlying atrophic RPE are generally nonfunctional and result in a scotoma.
The atrophic retinal pigment epithelium (RPE) demonstrates staining of the underlying choroidal vasculature. Normally, the intact RPE masks the presence of choroidal fluorescence. However, when the RPE atrophies, the underlying dye appears as an area of hyperfluorescence in the early stages of angiography. In the late stages, the drusen lose fluorescence in concert with (or with a small time lag) the rest of the retinal layers.
A more advanced case of dry age-related macular degeneration. Several areas of atrophy are present, as are areas of significant pigment mottling in the macula. The large drusen inferior to fixation are poorly distinguished from each other.
The atrophic areas are easily distinguished by the hyperfluorescence of the retinal pigment epithelium (RPE) in the mid phase of the angiogram. Hypofluorescence of dye, due to masking caused by the increased pigmentation, is seen. No areas of frank dye leakage or exudative age-related macular degeneration (ARMD) are apparent. A "hot cross bun" pattern of dry ARMD-related pigment changes is evident near the fovea.
High-definition optical coherence tomography scan of a 67-year-old woman showing retinal pigment epithelium mottling and pigment epithelial detachments temporal to fixation consistent with dry macular degeneration.
Fundus photo showing drusen in a 67-year-old woman with dry age-related macular degeneration.
Fluorescein angiogram 4 minutes after injection of dye on 67-year-old woman showing pigment epithelial detachments.
A later frame of the angiogram demonstrating the absence of dye leakage outside the lesion, with staining of the areas of atrophy (window defects) in the macular region.
High definition optical coherence tomography right eye demonstrating retinal pigment epithelium atrophy and changes in the deeper layers of retina. The absence of intraretinal cysts, subretinal fluid, or sub-retinal pigment epithelium fluid indicates the absence of wet age-related macular degeneration.
 
 
 
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