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Age-Related Macular Degeneration Revisited in Nature Reviews Disease Primers

Interview with Monika Fleckenstein, MD, on AMD Disease Primer

An international collaboration of scientists publishing in Nature Reviews Disease Primers this week advocate for a new way of thinking about and finding treatments for age-related macular degeneration (AMD)—the developed world’s leading cause of severe vision impairment for people aged 55 and older.

The article, which features the John A. Moran Eye Center’s Monika Fleckenstein, MD, as its first author, provides a global overview of the field of AMD, outlines key open research questions, and emphasizes a new paradigm. Citing about 280 research papers, the group points to a growing body of evidence that AMD is not one homogenous disease but instead comprises diverse pathological conditions.

"This effort gathered an elite team of clinicians, translational researchers, and basic scientists to give different perspectives on AMD," said Fleckenstein, part of Moran’s Sharon Eccles Steele Center for Translational Medicine (SCTM). "We hope the publication will inspire our colleagues to see AMD not as one single disease, but rather as a disease spectrum with distinct phenotypes with potentially differential underlying mechanisms of pathogenesis."

Steffen Schmitz-Valckenberg, MD, who holds a Jon M. Huntsman Presidential Chair at the University of Utah and directs Moran’s Utah Retinal Reading Center, explained the group’s view is "supported by two decades of progress that includes new high-resolution retinal imaging techniques, advanced measures to detect and quantify disease symptoms and pathology, and genetic studies."

The SCTM, directed by Gregory S. Hageman, PhD, has long embraced this concept and has developed a potential new therapy for AMD patients with genetic risk for the disease found in genes located on chromosome 1. The SCTM is planning clinical trials to test this therapeutic approach.

AMD may cause central vision loss and has long been viewed as one disease with two manifestations: exudative (wet) and non-exudative (dry). Exudative AMD takes its name from blood vessels that leak or rupture to cause distortion in vision, while non-exudative AMD is defined by the degeneration of retinal tissue resulting in atrophy of photoreceptors with irreversible vision loss. Both forms are proceeded by earlier stages characterized by the deposition of extracellular material that becomes apparent in the form of so-called drusen. To date, only the exudative component of AMD is treatable by repetitive intravitreal injection of therapeutics that inhibit vascular endothelial growth factor.

Nature Reviews Disease Primers is part of the Nature Reviews portfolio of journals. It is currently ranked No. 4 of 160 journals in "Medicine, General & Internal" by the Journal Citation Report with a Journal Impact Factor of 40.689. This journal aims to cover all major diseases and has become an invaluable resource for researchers and educators alike.

Authors on the primer, Age-Related Macular Degeneration, are: Monika Fleckenstein, Tiarnán D. Keenan, Robyn H. Guymer, Usha Chakravarthy, Steffen Schmitz-Valckenberg, Caroline C. Klaver, Wai T. Wong, and Emily Y. Chew.