Macular degeneration is the most common cause of legal blindness in the United States. There are about 10 million people affected in the United States by macular degeneration and one million are legally blind.

Macular degeneration is more common in Caucasians than other ethnic groups. Other risk factors include advancing age, smoking, unhealthy diet, and family history. Senior citizens who wish to reduce the risk of macular degeneration may benefit from increasing exercise, eating more green leafy vegetables, and quitting smoking.

There are two types of macular generation, dry and wet. Dry macular generation is more common (90%) but less severe. The wet type occurs only in 10% of patients with macular degeneration, but is the major cause of severe vision loss. In the wet type, abnormal blood vessels grow under the center of the retina (macula). These abnormal blood vessels leak and bleed, which results in the damage of photoreceptors.

Patients with macular degeneration suffer from loss of central vision, while peripheral vision is relatively preserved. Loss of central vision reduces one's ability to read, write, drive, and recognize people. The patient may gradually lose his or her independence. Until 1999, the only proven treatment for macular degeneration was laser photocoagulation. This type of laser was effective in treating abnormal blood vessels, but photoreceptors were damaged by the laser, too, reducing central vision. This collateral damage made laser undesirable for most patients.

Based on a large scale study by National Institute of Health's Age-Related Eye Disease Study, taking a combination of anti-oxidants and zinc is helpful to reduce the risk of macular degeneration. This supplement decreases the risk of macular degeneration by 25%. If eligible patients use the supplement, a quarter million people in the United States could be saved from vision loss in the next five years.

Currently there are two FDA approved treatments for wet macular degeneration. Photodynamic therapy is performed by intravenous injection of a photosensitizer

(currently Visudyne), which is activated by application of a low level of cold laser. This reduces the size of abnormal blood vessels. Another treatment, more recently approved by FDA, is Macugen. Macugen works against the growth factor for blood vessels (VEGF). Macugen is injected into the globe (intravitreal injection). Macugen is usually injected every six weeks. It stops growth of abnormal blood vessels.

Researchers at Yale and other institutions are developing a new generation of treatment for macular degeneration. Drs. Adelman and Garen and their research teams have developed a new treatment called neovascular targeted photodynamic therapy. This

technique selectively treats abnormal blood vessels while preserving normal vessels. This may reduce side effects and increase efficacy compared with current treatments. In the next five to ten years, even more effective treatments for macular degeneration will move out of the research laboratory and become available to patients.