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

1970s sketch illustrating break in Bruch’s membrane as underlying feature leading to the development of choroidal neovascularization.

Arnall Patz (right) and Arnold Palmer (left). Patz received the Presidential Medal of Freedom at the White House in June 2004 for establishing the relationship between oxygen and retinopathy of prematurity in low birth weight infants.

Edward Jackson (1856–1942).

Sketch illustrates well-defined choroidal neovascularization outside the fovea. Neovascular lesions in this location were shown to benefit from treatment with laser photocoagulation.

Reprinted with permission from Archives of Ophthalmology, Vol 100, p. 916, June 1982, “Cumulative Proportion of Eyes With Event (in MPS Trial of argon laser photocoagulation for extrafoveal choroidal neovascularization). Event has been defined as decrease in visual acuity of six or more lines from baseline. Dashed line indicates no treatment group; solid line, treatment group.”

Treatment of choroidal neovascularization in 1970s. Fluorescein angiogram shows well defined area of choroidal neovascularization not involving the foveal avascular zone.

Fluorescein angiogram shows area of classic choroidal neovascularization with adjacent area of abnormal fluorescence (arrow) now recognized as occult CNV. (A) Early phase angiogram. (B) Late phase angiogram.

Fluorescein angiogram shows marginal recurrent leakage under the fovea (arrow) in eye previously treated with laser for extrafoveal choroidal neovascularization.

Five year risk of developing CNV in the second eye as a function of the number of risk factors present. (See Table 2 and Reference 38).

Rabbit corneas eight days after implantation of bFGF pellets in central corneal pocket. (A) Control. (B) Thalidomide-treated. (Photographs courtesy of Robert D’Amato, MD, PhD, Harvard Medical School, Children’s Hospital of Boston.)

(A) Probability of developing visual acuity loss of at least 15 letters in at least one study eye of AREDS participants in AREDS Categories 3 and 4 by treatment group. (AREDS photographs courtesy of F.L. Ferris, MD, National Eye Institute). (B) Probability of developing advanced AMD in at least one eye of AREDS participants according to treatment group.

Fundus photographs of 60-year-old woman with large, confluent macular drusen in both eyes and a small hemorrhage with lipid exudates in the papillomacular bundle. (A) Right eye. (B) Left eye.

Fluorescein angiogram of patient showing subtle but definite hyperfluorescence (arrow) adjacent to macular hemorrhage, left eye. (A) Early phase angiogram. (B) Late phase angiogram

Patient illustrated in , nine months following laser photocoagulation to area of presumed choroidal neovascularization in papillomacular bundle of left eye. (A) Right macula (untreated). Compare with Figure 12A. (B) Left macula (laser treated). Compare with Figure 12B.

Choroidal Neovascularization Prevention Trial Study design for Fellow Eye Study and Bilateral Drusen Study.

Protocol treatment in Choroidal Neovascularization Prevention Trial. Initial laser treatment consists of 20 lesions in three arcs temporal to fovea.

Reprinted with permission from Ophthalmol Vol 110, No. 5 p. 974, May 2003. Rates of choroidal neovascularization in CNVPT Fellow Eye Study “Estimated cumulative proportion of eyes developing choroidal neovascularization by treatment group.” At no time was there a significant difference in visual outcome in treated fellow eyes vs untreated fellow eyes.

Location of 22 clinical centers participating in Complications of AMD Prevention Trial which is supported by the National Eye Institute.

Protocol laser treatment for Complications of AMD Prevention Trial (CAPT). (A) Initial laser treatment protocol. (B) Follow-up treatment protocol at one year.

Perls’ stain (blue) shows iron overload in the retinal pigment epithelium in ceruloplasmin/hephaestin deficient mice.

Figure reprinted with permission from Molecular Vision, September 2003; Vol 9, p. 188. Photomicrograph shows that anti-amyloid-beta-antibody 2332 detects a single vesicle and punctuate granular deposits within drusen.