Article Date: 3/1/2013

Book Review

Comprehensive AMD Reference Out in Second Edition

Frank G. Holz, Daniel Pauleikhoff, Richard F. Spaide, Alan C. Bird, eds. Age-related Macular Degeneration. 2nd ed. New York, NY; Springer; 2013.


Reviewing a new edition of a textbook usually requires an assessment of any changes made from previous editions. However, with the second edition of Age-related Macular Degeneration, such an attempt would mean writing a chapter in the history of medicine.

Since 2003, when the first edition of this book was published, we have witnessed tremendous advances in the knowledge and management of AMD. Over the past decade, the genetic basis for AMD has been increasingly unveiled. Scientific and technological progress has radically changed the diagnosis and follow-up, which are nowadays based on spectral-domain. Most importantly, the introduction to the ophthalmic armamentarium of anti-VEGF drugs has made it possible to reverse the once rather bleak prognosis of vision loss.

The editors profess that the aim of the book is to summarize the current level of knowledge of AMD. They have, indeed, accomplished their mission wonderfully, thanks to a handful of distinguished physicians and researchers, who have provided in the 320 pages of the book a clear and up-to-date succinct presentation of all aspects of AMD.

Oriel Spierer, MD, and Anat Loewenstein, MD, are on the faculty of the Department of Ophthalmology at Tel Aviv Medical Center in Israel. They do not report any financial interests in this book or publisher. Dr. Loewenstein can be reached via e-mail at

The book is structured into four sections: pathophysiology, clinical manifestations, diagnostics, and therapy and rehabilitation. Each chapter opens with core information and ends with a clinically oriented, take home–like summary, which is of great value.

For example, at the end of the chapter “Epidemiology of AMD,” after a comprehensive review of the possible risk factors, including genetic and environmental factors, the authors conclude that “patients with early AMD should be advised to take sufficient proportions of antioxidant, zinc, and omega-3 fatty acids, to not smoke, and to guard against hypertension.” In just a few words, the authors recap the proven means to slow the progression of AMD. Such conclusive messages are take-home pearls the book is offering to its reader.


The first section deals in depth with genetics and epidemiology, with very detailed information presented in tables and figures. Separate chapters address genetics and the complement system. Recent discoveries regarding the function of complement factor H (CFH), ARMS2/HTRA1, and other genes involved in the pathophysiology of AMD are appropriately put forward.

However, there is a little overlapping among Chapter 1 (Epidemiology), Chapter 2 (Genetics), and Chapter 4 (CFH) regarding the pathogenetic factors of AMD. In this section, the authors also review the major histopathologic findings in AMD: drusen, pigment epithelial detachment, choroidal neovascularization, and geographic atrophy.

A series of pathology-matched illustrations are included, such as histological, clinical, and imaging studies. The excellent choice and quality of illustrations throughout the book are worth noting.


The section presenting the clinical manifestations of AMD is a straightforward overview of the signs and symptoms of patients with early AMD, CNV, and GA. The authors discuss the difficulty at times in determining whether visual distortion is present, considering that Amsler grid testing for self-monitoring of AMD progression is suboptimal due to low sensitivity and specificity. Preferential hyperacuity perimetry may be used in general clinics as a screening tool, but it has considerable costs, while its sensitivity and specificity range from moderate to high.

More than a few lines are also dedicated to the recent developments made in the correlation between retinal areas with increased autofluorescence and the expansion of GA over time. Overall, this section is relatively short, as not much has changed over the last decade regarding the clinical aspect of AMD. Yet the clinician will find this section interesting and useful for daily practice.

With FA still the gold standard for imaging neovascular AMD, the role of OCT has gained momentum. Accordingly, a separate part is dedicated to SD-OCT, as it is the most practical tool for patient follow-up and to guide retreatment. As the use of time-domain OCT has been abandoned in clinical settings (but still encountered in various publications), this modality is only tangentially discussed and for the right reasons.


In contrast, the part describing the follow-up of patients treated with thermal laser or photodynamic therapy is obsolete. Along that line of thought, we are not sure whether it was necessary to devote a whole chapter (Chapter 13) to PDT and laser. One could argue that PDT is still investigated as a combined treatment with anti-VEGF, but as for thermal laser, this treatment was abandoned years ago. It might have been more reasonable to describe laser treatment in only a few lines for the rare cases of extrafoveal small classic CNV and to discuss PDT in more detail in the chapter reviewing combination therapies for CNV (see below).

Except for these issues, the section summarizing the therapeutic options for AMD is well organized and informative, as the authors review the multicenter, randomized clinical trials for treating early and neovascular AMD. The reader will find a comprehensive summary of anti-VEGF therapy, starting from the molecular basis and ending with treatment guidelines.

Anti-VEGF treatment, although clinically very successful, has some limitations. First, in most patients, it does not improve vision; it only preserves it. Second, frequent retreatments are necessary without a defined endpoint. Third, every injection carries a risk of endophthalmitis, cataract, and retinal tear or detachment.

In addition, anti-VEGF targets only the angiogenic component of CNV but not other components, ie, vascular and inflammatory factors. Based on this reasoning, several recent clinical trials have investigated the combination of anti-VEGF, PDT, corticosteroids, and radiation for the treatment of CNV. The authors methodologically review the studies on different combination protocols. As we know, for today, the optimal combination regimen has yet to be determined.


The last part of the book — “Rehabilitation” — discusses low-vision aids and how to restore reading ability in AMD patients. Frankly, clinicians who treat patients with AMD usually refer them to optometrists for low-vision aids, mainly because of a very limited understanding in that area.

However, despite the lack of expertise, we are not exempt as AMD specialists from needing to be familiar with these issues, so we can at least provide information to our patients. Therefore, we believe that the concise summary regarding rehabilitation is an important addition to this book. The reader should also remember that longer life expectancy and the aging of the Baby Boom generation may result in an increase in the number of visually impaired patients.

In summary, this newly published book covers all areas of AMD and is well written and edited. Plenty of high-resolution clinical and macular imaging photos are included, as well as organized tables and clear figures. We believe that it represents a reference tool for AMD and a must-have book for retina specialists, general ophthalmologists, and residents and fellows in ophthalmology. Researchers in the field of AMD may also benefit from this excellent overview. RP

Retinal Physician, Volume: 10 , Issue: March 2013, page(s): 15 16