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This comparison of ranibizumab and bevacizumab to treat neovascular age-related macular degeneration showed equivalent efficacy in maintaining visual acuity. Bevacizumab was associated with more serious adverse events (mainly hospitalizations). In 2005, clinical trials established the efficacy of ranibizumab 1 , 2 (Lucentis, Genentech) for the treatment of neovascular age-related macular degeneration (AMD), the leading cause of legal blindness in the United States. While awaiting approval for ranibizumab from the Food and Drug Administration, ophthalmologists began treating neovascular AMD with off-label use of bevacizumab (Avastin, Genentech), since the drug had a target specificity similar to that of ranibizumab and was available at low cost. 3 , 4 Because the intraocular safety of bevacizumab and the duration of its therapeutic effect were unknown, the drug was usually administered only when there were signs of active . . .

Dr. Daniel Martin and colleagues describe their experience with a comparative-effectiveness study that highlights important roadblocks and dramatic changes needed in federal infrastructure for such research to be conducted efficiently. Patient-advocacy and health policy groups have hailed comparative-effectiveness research (CER) as a means of reducing health care costs without compromising the quality of care. The federal commitment of $1.1 billion under the American Recovery and Reinvestment Act (ARRA) ensures that the scientific community will undertake considerable amounts of such research. Yet major federal policy changes and innovative measures were required before one CER study, “Comparison of Age-Related Macular Degeneration [AMD] Treatments Trials (CATT),” could even be launched. Our experience with CATT highlights important roadblocks and dramatic changes needed in federal infrastructure for CER to be conducted efficiently. In July 2005, . . .

Age-related macular degeneration, a deterioration of the central portion of the retina, is the chief cause of severe and irreversible loss of vision in developed countries. 1 , 2 There is no effective treatment for most patients with age-related macular degeneration, and many patients therefore resort to experimental treatments. Physicians must know how to counsel their patients about the limitations and risks of these experimental therapies. Fortunately, several clinical trials sponsored by both the National Eye Institute and the private sector are evaluating novel prophylactic and therapeutic interventions. In addition, there is much exciting, ongoing basic research, some of which may lead . . .

Diabetic macular edema (DME) is a leading cause of vision loss in older Americans. Thermal laser treatment remains the mainstay of treatment for DME. Recently, alternative primary treatments for DME have been evaluated. These treatments include intravitreal injections of steroids as well as pharmaceuticals containing antibodies against vascular endothelial growth factor (VEGF). Surgical treatment has been shown to be appropriate in selected cases. We review the evidence and scientific rationale for various primary treatment options in patients with DME. Regular and timely ophthalmologic evaluation remains crucial to recognition and treatment of macular edema in diabetic patients.

In December 2004, pegaptanib sodium (Macugen; Eyetech/Pfizer), which targets vascular endothelial growth factor, was approved by the US FDA for the treatment of neovascular age-related macular degeneration. As well as being the first anti-angiogenic agent to be approved for this common eye disorder, it is also the first approved therapeutic based on an RNA structure known as an aptamer.

Fine et al discuss age-related macular degeneration, which is a deterioration of the central portion of the retina. It is the chief cause of severe and irreversible loss of vision in developed countries. The clinical features and classification of this disease, as well as its diagnosis and treatment are discussed.

To the Editor: Bevacizumab is the predominant agent used for the treatment of neovascular age-related macular degeneration (AMD) worldwide, and the study by the Comparison of AMD Treatments Trials (CATT) research group (May 19 issue) 1 should have far-reaching influence on global practice patterns. 2 However, considerable uncertainty is likely to remain in Asia, whose population was not addressed by CATT. The unfortunate truth remains that 80% of all new drugs are discovered in the United States and Europe, are tested in subjects of European descent, and are then administered to Asians on the presumption of similar therapeutic response. 3 Increasing evidence suggests . . .

We executed a genome-wide association scan for age-related macular degeneration (AMD) in 2,157 cases and 1,150 controls. Our results validate AMD susceptibility loci near CFH (P < 10−75), ARMS2 (P < 10−59), C2/CFB (P < 10−20), C3 (P < 10−9), and CFI (P < 10−6). We compared our top findings with the Tufts/Massachusetts General Hospital genome-wide association study of advanced AMD (821 cases, 1,709 controls) and genotyped 30 promising markers in additional individuals (up to 7,749 cases and 4,625 controls). With these data, we identified a susceptibility locus near TIMP3 (overall P = 1.1 × 10−11), a metalloproteinase involved in degradation of the extracellular matrix and previously implicated in early-onset maculopathy. In addition, our data revealed strong association signals with alleles at two loci (LIPC, P = 1.3 × 10−7; CETP, P = 7.4 × 10−7) that were previously associated with high-density lipoprotein cholesterol (HDL-c) levels in blood. Consistent with the hypothesis that HDL metabolism is associated with AMD pathogenesis, we also observed association with AMD of HDL-c—associated alleles near LPL (P = 3.0 × 10−3) and ABCA1 (P = 5.6 × 10−4). Multilocus analysis including all susceptibility loci showed that 329 of 331 individuals (99%) with the highest-risk genotypes were cases, and 85% of these had advanced AMD. Our studies extend the catalog of AMD associated loci, help identify individuals at high risk of disease, and provide clues about underlying cellular pathways that should eventually lead to new therapies.

The Wilmer Retinal Vascular Center's experience with central serous chorioretinopathy from 1970 to the end of 1979 was reviewed and compared with previous studies. Retrospective analysis of 73 patients seen at follow-up suggests no clinically significant effect of focal argon laser photocoagulation on final visual acuity or recurrence rate. Patients with initial visual acuity of 20/20 remained at that level, and patients with initial visual acuity of less than 20/30 gained, on average, two to three Snellen lines at follow-up. Approximately one-third of both untreated and treated patients had recurrence or presumed persistence during the follow-up period. With the inclusion of episodes that occurred before the first Wilmer Institute visit about half of each group had recurrence or presumed persistence. Recurrences were most often due to leakage from a site within one disc diameter of the original site of leakage.