Introduction
A
ge-related macular degeneration (AMD) is
now one of the major causes of central vision
loss. It involves the macular area and when it
progresses and destroys the central fovea, qual-
ity of life is seriously compromised. The ability to read,
drive, recognize faces or watch television is impaired or
lost. It is a disease associated with aging and progressive
tissue degeneration. Most of these senior citizens had
anticipated the opportunity to enjoy life at leisure doing
their preferred activities and find profound limitations
and are deeply disappointed in their expectations.
This was the dismal state of affairs until a few years
ago when the introduction of new therapeutic agents
changed dramatically the expected outcome. The most
important development has been the clinical dem-
onstration that agents inhibiting vascular endothelial
growth factor and, therefore, the formation and devel-
opment of new vessels not only preserve visual acuity
but also improve visual function. This find was a true
revolution in ophthalmology. The retina like the cen-
tral nervous system, particularly in old age, was not
considered capable of regeneration and, therefore, new
therapies were expected to offer only stabilization of the
disease. When laser photocoagulation was shown to be
effective for the treatment of diabetic retinopathy this
was a breakthrough but it offered only stabilization of
the disease and maintenance of visual acuity present at
time of treatment. Now, new available treatments offer
real improvement in visual acuity, implicating improved
visual function and some degree of recovery of the reti-
nal neuronal network.
AMD is, therefore, an active scientific area with new
information becoming available almost everyday on the
pathophysiology, clinical phenotypes, markers of dis-
ease progression, new treatments and novel treatment
regimens. It is a complex multifactorial disease where
aging associates with genetic factors and inflammatory
responses to local cell injury. This means that the treat-
ment of AMD must also address the various factors
involved in disease progression and, most likely, will
involve a combination of therapies after clear identi-
fication of the different AMD phenotypes. This book
reviews the new concepts on AMD and is, therefore,
timely. It is a concerted effort of Portuguese ophthal-
mologists which together with a few other European
experts in the field cover the subject paying particular
attention to daily practice management of AMD.
I am particularly happy to see this collaborative
effort coming from my country, Portugal. It shows
that Portuguese ophthalmology is at the forefront of
European and International ophthalmology. It shows
also that there is in Portugal a real spirit of collabora-
tion between colleagues working together to improve
the vision of their patients.
Author:
José Cunha-Vaz, MD, PhD
Association for Innovation and Biomedical Research
on Light and Image (AIBILI), Coimbra, Portugal
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