BACKGROUND:Age-related macular degeneration (ARMD) is the leading cause of visual disability in people over 60 years of age in the developed world. The success of treatment deteriorates with increased latency of diagnosis. The purpose of this study was to determine the reliability of the macular mapping test (MMT), and to investigate its potential as a screening tool.METHODS:The study population comprised of 31 healthy eyes of 31 participants. To assess reliability, four macular mapping test (MMT) measurements were taken in two sessions separated by one hour by two practitioners, with reversal of order in the second session. MMT readings were also taken from 17 age-related maculopathy (ARM), and 12 AMD affected eyes.RESULTS:For the normal cohort, average MMT scores ranged from 85.5 to 100.0 MMT points. Scores ranged from 79.0 to 99.0 for the ARM group and from 9.0 to 92.0 for the AMD group. MMT scores were reliable to within +/- 7.0 points. The difference between AMD affected eyes and controls (z = 3.761, p = < 0.001) was significant. The difference between ARM affected eyes and controls was not significant (z = -0.216, p = 0.829).CONCLUSION:The reliability data shows that a change of 14 points or more is required to indicate a clinically significant change. This value is required for use of the MMT as an outcome measure in clinical trials. Although there was no difference between MMT scores from ARM affected eyes and controls, the MMT has the advantage over the Amsler grid in that it uses a letter target, has a peripheral fixation aid, and it provides a numerical score. This score could be beneficial in office and home monitoring of AMD progression, as well as an outcome measure in clinical research.

Purpose: Cholesterol homeostasis in neuronal structures is driven by at least three independent mechanisms: apolipoprotein E (apoE), ATP Binding Cassette Transporter A1 (abca1) and cholesterol 24-hydroxylase (CYP46). CYP46 gene polymorphism and circulating levels of its metabolic product, 24-hydroxycholesterol, may be linked to neurodegenerative diseases. Preliminary data from our research group have shown that CYP46 is specifically expressed in the neural retina. In the present work, we aimed to examine the association of a single nucleotide polymorphism in intron 2 of the CYP46 gene with age-related macular degeneration (AMD) or primary open-angle glaucoma (POAG), two pathologies concerned by neurodegenerative mechanisms. Methods: The frequency of CYP46*C and CYP46*T alleles was analyzed in 55 AMD patients (79+/-8yr), 64 glaucoma patients (67+/-14yr) and 75 control subjects (68+/-15yr). The presence or absence of disease in patients and controls was based on clinical examination. A blood sample was collected for DNA extraction. The common allelic variants of apoE and CYP46*C/CYP46*T alleles were screened through the use of polymerase chain reaction using appropriate primers and restriction enzyme digestion (HhaI for apoE, MspI for CYP46). Genotype frequencies were compared in patients and controls by 2x2 contingency tables and two-tailed P values calculated using Fisher?s exact test. Results: The frequency of CYP46*T allele was higher in AMD and POAG patients compared to controls (0.77 and 0.81 compared to 0.73, respectively). Only the difference between POAG patients and control subjects was significant (p<0.05). The odd ratio for the risk of developing glaucoma was estimated to 1.83 (95% confidence interval: 0.93-3.62) and 1.23 in AMD (95% confidence interval: 0.61-2.48). The frequency of the E2 and E4 alleles was slightly higher in glaucoma and AMD patients respectively. Nevertheless, the difference failed to reach statistical significance. Conclusions: Our results support the role of cholesterol homeostasis via CYP46 in the retina. They suggest that CYP46 polymorphism may be involved in the development of neurodegenerative diseases in the eye as it has already been shown in the brain. Finally, cholesterol metabolism may be impaired in POAG and AMD.

Background: Until recently, only two options were available for the treatment of choroidal neovascularisation (CNV) associated with age related macular degeneration (AMD)?thermal laser photocoagulation and photodynamic therapy with verteporfin (PDT-V). However, new treatments for CNV are in development, and data from phase III clinical trials of some of these pharmacological interventions are now available. In light of these new data, expert guidance is required to enable retina specialists with expertise in the management of AMD to select and use the most appropriate therapies for the treatment of neovascular AMD. Methods: Consensus from a round table of European retina specialists was obtained based on best available scientific data. Data rated at evidence levels 1 and 2 were evaluated for laser photocoagulation, PDT-V, pegaptanib sodium, and ranibizumab. Other treatments discussed are anecortave acetate, triamcinolone acetonide, bevacizumab, rostaporfin (SnET2), squalamine, and transpupillary thermotherapy. Results: PDT-V is currently recommended for subfoveal lesions with predominantly classic CNV, or with occult with no classic CNV with evidence of recent disease progression and a lesion size [<=]4 Macular Photocoagulation Study (MPS) disc areas (DA). The new classes of anti-angiogenic agents?namely, pegaptanib sodium and ranibizumab (the latter when peer reviewed phase III data become available) are recommended for subfoveal lesions with any proportion of classic CNV or occult with no classic CNV. For juxtafoveal classic CNV, PDT-V or anti-angiogenic therapy should be considered if the new vessels are so close to the fovea that laser photocoagulation would almost certainly extend under the centre of the foveal avascular zone. For all other well demarcated juxtafoveal lesions and for extrafoveal classic lesions, laser photocoagulation remains the standard treatment. Therapy should be undertaken within 1 week of the fluorescein angiogram on which the clinical decision to treat is based. At each follow up, fluorescein angiography should be performed and best corrected visual acuity measured as a minimum requirement. Conclusions: These recommendations provide evidence based guidance for the choice and use of non-surgical therapies for the management of neovascular AMD. Revisions of the recommendations may be required as new data become available.