Age-Related Macular Degeneration: A Comprehensive Textbook
http://www.100md.com
《新英格兰医药杂志》
In the spectrum of eye diseases, few rival age-related macular degeneration. Moderately advanced dry macular degeneration alone is estimated to affect more than 8 million Americans over 55 years of age. Age-related macular degeneration is the leading cause of vision loss in developed nations, accounting for more than 50% of the cases of blindness, and it has a profound effect on the quality of life — some legally blind patients with the condition have been known to say they would give up 50% of their remaining years in exchange for perfect vision.
There has been a considerable effort to find new therapies for age-related macular degeneration. In Age-Related Macular Degeneration, D. Virgil Alfaro III and his colleagues have drawn together an international group of collaborators to take on the daunting task of compiling the collective knowledge of a field that is rapidly evolving and constantly incorporating new breakthroughs. For the most part, the editors achieve their intended goal. The book has 30 chapters divided into 6 sections, each of which, Alfaro asserts in his preface, "can stand alone as an academic treatise."
The first two sections are a primer on the anatomy, physiology, and disease spectrum of age-related macular degeneration. While touching on the pertinent aspects, the chapters in these sections also outline the retinal abnormalities associated with the condition, relying somewhat on the reader to fill in the details. These chapters would have benefited from additional diagrams to help clarify some of the concepts presented in the text. The third section focuses on retinal imaging. The chapters in this section are mostly an introduction to the wide variety of approaches now available to capture images of the retina. It begins with a chapter on the differential diagnosis of age-related macular degeneration that includes an impressive array of images of the fundus as well as angiographic images. Separate chapters, both well written and well illustrated, focus on fluorescein and indocyanine green angiography. Chapters devoted to optical coherence tomography, scanning laser ophthalmoscopy, and retinal-thickness analyzers end the section and draw hopeful conclusions about their role in the diagnosis of age-related macular degeneration. The brief chapter on the role of antioxidants and free radicals in age-related macular degeneration could have benefited from a more detailed review of the evidence — in particular, the results of the Age-Related Eye Disease Study. The final two sections, the real substance and strength of the book, are up-to-date and complete reviews of two key areas of age-related macular degeneration — treatment and future directions.
With great depth and clarity, the book reviews the latest established and emerging therapies. There is a wonderful summary of photodynamic therapy with verteporfin, which can prevent progressive visual loss in age-related macular degeneration; included are the findings of the Treatment of Age-Related Macular Degeneration with Photodynamic Therapy Study and the Verteporfin in Photodynamic Therapy Study. Of particular note are the chapters devoted to pegaptanib sodium and ranibizumab. These therapies were developed from evidence implicating vascular endothelial growth factor as the central signal in ocular neovascularization and age-related macular degeneration. Both chapters include excellent diagrams and up-to-date summaries of the clinical evidence.
Excellent review chapters cover the gamut of treatments, and for good measure there is a succinct chapter outlining the potential role of intravitreal triamcinolone in the treatment of choroidal neovascularization in age-related macular degeneration. The last section introduces future avenues of research such as gene therapy, retinal transplantation, and neuroprotection. The only deficiency we could detect was the absence of a comprehensive section on health policy to review the effects of various treatments in terms of the quality of life and cost effectiveness.
In summary, Age-Related Macular Degeneration is an important reference and a comprehensive update on the subject of age-related macular degeneration. Much of the material covering the recent evidence in support of new therapies is timely. The book is a substantial achievement that will serve ophthalmologists and vitreoretinal specialists well.
Sanjay Sharma, M.D.
Jonathan Wong, M.D.
Queen's University
Kingston, ON K7L 3N6, Canada(Edited by D. Virgil Alfar)
There has been a considerable effort to find new therapies for age-related macular degeneration. In Age-Related Macular Degeneration, D. Virgil Alfaro III and his colleagues have drawn together an international group of collaborators to take on the daunting task of compiling the collective knowledge of a field that is rapidly evolving and constantly incorporating new breakthroughs. For the most part, the editors achieve their intended goal. The book has 30 chapters divided into 6 sections, each of which, Alfaro asserts in his preface, "can stand alone as an academic treatise."
The first two sections are a primer on the anatomy, physiology, and disease spectrum of age-related macular degeneration. While touching on the pertinent aspects, the chapters in these sections also outline the retinal abnormalities associated with the condition, relying somewhat on the reader to fill in the details. These chapters would have benefited from additional diagrams to help clarify some of the concepts presented in the text. The third section focuses on retinal imaging. The chapters in this section are mostly an introduction to the wide variety of approaches now available to capture images of the retina. It begins with a chapter on the differential diagnosis of age-related macular degeneration that includes an impressive array of images of the fundus as well as angiographic images. Separate chapters, both well written and well illustrated, focus on fluorescein and indocyanine green angiography. Chapters devoted to optical coherence tomography, scanning laser ophthalmoscopy, and retinal-thickness analyzers end the section and draw hopeful conclusions about their role in the diagnosis of age-related macular degeneration. The brief chapter on the role of antioxidants and free radicals in age-related macular degeneration could have benefited from a more detailed review of the evidence — in particular, the results of the Age-Related Eye Disease Study. The final two sections, the real substance and strength of the book, are up-to-date and complete reviews of two key areas of age-related macular degeneration — treatment and future directions.
With great depth and clarity, the book reviews the latest established and emerging therapies. There is a wonderful summary of photodynamic therapy with verteporfin, which can prevent progressive visual loss in age-related macular degeneration; included are the findings of the Treatment of Age-Related Macular Degeneration with Photodynamic Therapy Study and the Verteporfin in Photodynamic Therapy Study. Of particular note are the chapters devoted to pegaptanib sodium and ranibizumab. These therapies were developed from evidence implicating vascular endothelial growth factor as the central signal in ocular neovascularization and age-related macular degeneration. Both chapters include excellent diagrams and up-to-date summaries of the clinical evidence.
Excellent review chapters cover the gamut of treatments, and for good measure there is a succinct chapter outlining the potential role of intravitreal triamcinolone in the treatment of choroidal neovascularization in age-related macular degeneration. The last section introduces future avenues of research such as gene therapy, retinal transplantation, and neuroprotection. The only deficiency we could detect was the absence of a comprehensive section on health policy to review the effects of various treatments in terms of the quality of life and cost effectiveness.
In summary, Age-Related Macular Degeneration is an important reference and a comprehensive update on the subject of age-related macular degeneration. Much of the material covering the recent evidence in support of new therapies is timely. The book is a substantial achievement that will serve ophthalmologists and vitreoretinal specialists well.
Sanjay Sharma, M.D.
Jonathan Wong, M.D.
Queen's University
Kingston, ON K7L 3N6, Canada(Edited by D. Virgil Alfar)