Molecular Vision 1999; 5:24 <http://www.molvis.org/molvis/v5/p24/> Received 24 May 1999 | Accepted 2 November 1999 | Published 3 November 1999

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The pathogenesis of age-related macular degeneration

Peter A. Campochiaro
 
 

The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD

Correspondence to: Peter A. Campochiaro, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Maumenee 719, 600 North Wolfe Street, Baltimore, MD, 21287-9277; Phone: (410) 955-5106; FAX: (410) 614-9315; email: pcampo@jhmi.edu

Age-related macular degeneration (AMD) represents one of the most difficult problems faced by ophthalmologists and vision scientists. It is the most common cause of severe vision loss in patients over the age of 60 in developed countries. As populations age, its prevalence increases. It is frustrating to ophthalmologists, because there is so little to offer in the way of treatment. It is frustrating to vision scientists, because its pathogenesis is enigmatic and it behaves like several diseases in one, and demands expertise in such disparate areas as neurodegeneration and vascular biology. It is frustrating to patients because as life-span is increasing, AMD is stealing away independence and quality of life, tarnishing the golden years.

As we approach the next millennium, it is worth assessing where we are and where we should be going with regards to AMD research. For this reason, an international symposium titled "Pathogenesis and Treatment of Age-Related Macular Degeneration: Current Knowledge and Leads for Future Research" was co-sponsored by the Wilmer Eye Institute and the Foundation Fighting Blindness and held at the Johns Hopkins University School of Medicine on June 4-6, 1998. There were 10 sessions that dealt with pathogenesis and 3 that dealt with treatment: (1) Clinical features and natural history, (2) Epidemiology, (3) Pathology, (4) Genetics, (5) What can we infer about AMD from other retinal degenerations, (6) Cell death, (7) Oxidative damage, (8) Senescence of retinal pigmented epithelial cells, (9) Choroidal neovascularization: extracellular matrix, stimulators, and inhibitors, (10) Changes in the choriocapillaris and retinal pigmented epithelial associated with choroidal neovascularization, (11) Current treatments in use or under investigation, (12) Potential future treatments for patients, (13) Current and potential future surgical treatments.

Prior to the meeting, the chairpersons for each session directed an email workshop from which a list of critical questions was generated. Guidelines and abstracts for each presentation were discussed. The chairperson from each of the 10 sessions dealing with pathogenesis agreed to summarize their session and workshop (for the pathology session there are two articles). The result is the following 11 articles:

1. The natural history of geographic atrophy, the advanced atrophic form of age-related macular degeneration

2. Epidemiology of Age-Related Macular Degeneration

3. Histopathology of Age-Related Macular Degeneration

4. Molecular Composition of Drusen as Related to Substructural Phenotype

5. The Genetics of Age-related Macular Degeneration

6. What can we learn about AMD from other retinal diseases?

7. Cell death in age-related macular degeneration

8. Oxidative damage and age-related macular degeneration

9. Senescence of the retinal pigment epithelium

10. The Pathogenesis of Choroidal Neovascularization in Patients with Age-related Macular Degeneration

11. Changes in Choriocapillaris and Retinal Pigment Epithelium (RPE) in Age-Related Macular Degeneration

The goal of these articles is not to answer all questions concerning the pathogenesis of AMD, but rather to give an appraisal of the current state of knowledge in the area and pose a few key questions that need to be addressed to advance that state of knowledge. It is the intent and hope of the meeting participants to stimulate thought and communication to help solve the AMD riddle.

Acknowledgements

The conference was supported by grants from Odette Wurzberger and the Foundation Fighting Blindness.