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Subretinal mechanisms may allow early AMD treatment, physicist suggests

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NEW YORK — Treatments that focus on subretinal mechanisms, such as fluid passage through Bruch’s membrane, may allow earlier treatment of age-related macular degeneration, a speaker here suggested.

John Marshall, PhD, said it may be possible to delay the onset of AMD by delaying some of the aging processes in posterior segment structures. He spoke about his ideas for new AMD treatment paradigms here at Macula 2006.

“We are probably treating [AMD] too late,” he said. “I would like to see prophylactic treatment either with laser treatment or with newer therapies.”

Biomechanical changes connected with collagen cause initial aging of the retina, and later aging is caused by an increase in the presence of lipid under the retina, Dr. Marshall said. There is an increase in the presence of lipids in Bruch’s membrane as patients age, he said, and as a result fluid transport and carrier transport of proteins decay exponentially with age.

Laser treatment of Bruch’s membrane might help clear out the lipids, he suggested. Selective treatment of the retinal pigment epithelium with short laser pulses placed marginally, away from the macula, could cause a “major” change in the rate of fluid movement, he said.