Faculty Bibliography

The neovascular variant of age-related macular degeneration is amenable to laser photocoagulation treatment within well-defined guidelines established by clinical trials. However, only a limited number of patients meet eligibility criteria for this form of treatment, principally because of the ill-defined, or occult nature, of the choroidal neovascularization commonly seen. Previous studies have estimated that one half of patients with neovascular age-related macular degeneration have occult neovascularization at initial manifestation of the disease. We examined the initial findings of 67 patients with newly diagnosed unilateral neovascular age-related macular degeneration. Eighty-seven percent of these patients (58 of 67) had disease that did not meet Macular Photocoagulation Study Group guidelines for laser photocoagulation treatment. As so few patients are eligible for laser photocoagulation, further research into new techniques of diagnosis and treatment for this disorder is warranted

The use of indocyanine-green videoangiography as an adjunctive technique to fluorescein angiography in the diagnosis of choroidal neovascularization has recently gained widespread attention. In January 1993, the first international symposium on indocyanine-green angiography was sponsored by the Manhattan Eye, Ear, and Throat Hospital. Approximately 300 retina specialists from all over the world convened at this meeting. Our current knowledge of indocyanine-green videoangiography is reviewed

Purpose: The study was designed to evaluate the relative anatomic position of the crossing vessels at the site of occlusion in eyes with branch retinal vein occlusion (BRVO). Methods: Fundus photographs of 106 eyes (104 patients) with recent BRVO from the Eye Disease Case-Control Study were used to examine the relative position of artery and vein at occluded crossings. Three separate comparison groups were formed by identifying corresponding arteriovenous crossings for each occluded crossing in: (1) the ipsilateral but opposite vessel arcade within eyes affected by BRVO; (2) the same quadrant in unaffected eyes of BRVO patients; and (3) the same quadrant in eyes of patients without BRVO, matched by age, sex, and race with the BRVO patients. Results: The site of obstruction of the branch vein was an arteriovenous crossing in all affected eyes. In 99% of eyes with BRVO, the artery was located anterior to the vein at the obstructed site. In the three comparison groups, the artery was anterior to the vein in 62%, 61%, and 54% of the crossings, respectively, yielding statistically significant differences for each group of control crossings compared with BRVO crossings (P < 0.001). Conclusion: Finding the vein to be consistently between the more rigid artery and the retina at almost all arteriovenous crossings affected by BRVO suggests a possible role for mechanical obstruction in the pathogenesis of BRVO. $$:

We evaluated the hypothesis that higher serum levels of micronutrients with antioxidant capabilities may be associated with a decreased risk of neovascular age-related macular degeneration by comparing serum levels of carotenoids, vitamins C and E, and selenium in 421 patients with neovascular age-related macular degeneration and 615 controls. Subjects were classified by blood level of the micronutrient (low, medium, and high). Persons with carotenoid levels in the medium and high groups, compared with those in the low group, had markedly reduced risks of neovascular age-related macular degeneration, with the levels of risk reduced to one half and one third, respectively. Although no statistically significant protective effect was found for vitamin C or E or selenium individually, an antioxidant index that combined all four micronutrient measurements showed statistically significant reductions of risk with increasing levels of the index. Although these results suggest that higher blood levels of micronutrients with antioxidant potential, in particular, carotenoids, maybe associated with a decreased risk of the most visually disabling form of age-related macular degeneration, it would be premature to translate these findings into nutritional recommendations

The objective of this case-control study of idiopathic retinal detachment was to evaluate previously suggested hypotheses about risk factors for retinal detachment and to investigate whether new ocular or systemic risk factors could be identified. Between 1986 and 1990, data were obtained at five US clinical centers on 253 patients with idiopathic retinal detachment and 1, 138 controls. Patients with pathologic myopia were excluded. Data were collected from interviews, clinical examinations, and laboratory analyses of blood samples. Only one clearly relevant risk factor, myopia, emerged from the analyses. An eye with a spherical equivalent refractive error of -1 to -3 diopters had a fourfold increased risk of retinal detachment compared with a nonmyopic eye; if the refractive error was greater than -3 diopters, the risk was increased 10-fold. The data suggest that almost 55% of nontraumatic detachments in eyes without previous surgery are attributable to myopia. The etiology of retinal detachment appears to be related to the architecture of the eye. The study found no evidence that systemic factors, particularly cardiovascular factors, play a role. $$:

Neovascular age-related macular degeneration (AMD) is one of five retinal disorders studied in the Eye Disease Case-Control Study. Data were obtained from 421 patients with neovascular AMD and 615 controls on a broad array of possible risk factors through interviews, clinical examinations, and laboratory analyses of blood samples. Decreased risk of neovascular AMD was associated with higher levels of carotenoids in the serum samples, higher horizontal cup-to-disc ratios, and use of postmenopausal exogenous estrogens in women. Increased risk of neovascular AMD was associated with cigarette smoking, higher levels of serum cholesterol, and parity greater than zero. No support was found for sunlight exposure, serum zinc levels, or iris color as risk factors for this disease. Although no association was found with a history of cardiovascular disease itself, the associations with post-menopausal exogenous estrogen use, cigarette smoking, and serum cholesterol level are consistent with a hypothesis linking risk factors for cardiovascular disease with neovascular AMD. The association noted between serum carotenoid levels and neovascular AMD supports the hypothesis that higher levels of micronutrients with antioxidant capabilities may decrease the risk of AMD. $$:

This is a report of nine patients who experienced sudden, severe, unilateral central vision loss following a flulike illness. Each patient had an exudative detachment of the macula. All patients experienced a spontaneous resolution of the acute macular manifestations with near-complete recovery of vision. A characteristic 'bull's-eye' appearance in the macula persisted. The acute manifestations of the disorder did not recur in any of the patients during the period of follow-up. The constellation of findings was suggestive of an inflammatory disease of the retinal pigment epithelium, but a specific causative agent could not be identified. The acute clinical and angiographic features, the natural course, and the residual pigment epithelial derangement were not consistent with any previously described disorder