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Consultation and Counseling

We have touched on the cultural diversity and linguistic differences among the Asian races. Ethnically the Asians who often request this type of cosmetic surgery include Chinese, Japanese, Koreans, Philippinos and South-East Asians. It is important to note that in these ethnic groups often more than half of the overall population do have an upper lid crease and that you may be consulting with a patient…

The Eyelid Crease: Goals and Benchmarks

In the opening chapter of this book I discussed, in common terms but in an exacting way, what an eyelid crease is, both from a layman's point of view as well as from a scientific neuromuscular standpoint. The two are complementary. Figure 4-1 shows a typical Asian eyelid without a crease, usually denoted as a ‘single eyelid’ or ‘mono-lid’ (but remember that the incidence of absent…

Comparative Anatomy of the Eyelids

The Upper Lid and Crease Studies have shown that about 50% of Asians do not have an upper eyelid crease; the other 50% have at least some form of crease. Eyes without a lid crease are described as having a ‘single eyelid’ ( Figure 3-1 ), whereas those with two segments of lid between the eyebrow and the eyelashes have ‘double eyelids’ ( Figure 3-2 ).…

Basic and clinical studies of AMD in future: questions more than answers

Epidemiology models herald a challenging future According to various forecasting models, life expectancy is projected to increase worldwide. There is a more than a 50% probability that by 2030 in 35 industrialized countries studied, national female life expectancy will break the 90-year barrier. In several countries on the top of this list, there is a roughly 27% probability that by 2030, male life expectancy will surpass…

Therapy in pipeline for age-related macular degeneration

The therapeutic pipeline for dry AMD The dry age-related macular degeneration (AMD) affects approximately 85%–90% of individuals with AMD. Geographic atrophy (GA), an advanced form of dry AMD, presents as a discrete area of retinal pigment epithelium (RPE) loss accompanying with the degeneration of overlying photoreceptors. Many of these individuals experience progressive and severe loss of vision when the center of macula is involved. The central…

Management of age-related macular degeneration

Age-related macular degeneration (AMD) is a multifactorial disorder with heterogeneous clinical features. Based on clinical and multimodal imaging studies, AMD has been classified with a great extent of consensus into early-stage, that is, from medium- to large-sized drusen and retinal pigmentary abnormalities and late-stage, that is, atrophic and neovascular. At different stages, multiple cell types of retina and choroid, as well as immune cells, interact and…

Genetics of age-related macular degeneration

Mendelian diseases and complex diseases The contribution of genetics to human disease has been long recognized. The genetic bases of the diseases may be monogenic or complex in origin. In monogenic Mendelian diseases, a mutation in a single gene transmitted in families predominantly leads to devastating phenotypic outcomes. Therefore, they are termed as simple genetic diseases. , Mendelian diseases, typically rare and very infrequently encountered at…

Pathogenesis of neovascular age-related macular degeneration

Angiogenesis and CNV formation Angiogenesis is the process of new vessel formation from preexisting ones. Under physiological and developmental conditions, angiogenesis is tightly regulated by a coordinated balance between pro- and antiangiogenic factors. Alterations in this fine-tuned balance could possibly lead to the increased production of proangiogenic mediators and the loss of inhibitory factors. For instance, neovascular AMD (nAMD) is characterized by the loss of this…

Pathogenesis of age-related macular degeneration

Pathophysiology of macular neurovascular complex in AMD The pathophysiologic process of age-related macular degeneration (AMD) primarily plays out in photoreceptor/RPE/Bruch's membrane/choriocapillaris (PR/RPE/BrM/CC) complex in the macular region. In this complex, retinal pigment epithelium (RPE), the central component, is a neuro-epithelial monolayer that acts as a metabolic interface between the choroid and the neurosensory retina. The RPE cells are connected by tight intercellular junctions, forming the outer…

Diagnosis of age-related macular degeneration

History and risk factors of AMD Age-related macular degeneration (AMD) is a clinical diagnosis based on characteristic macular findings in individuals over 50 years old. Age is one of the most important diagnostic criteria for AMD. The Beaver Dam Eye Study compared the 5-year incidence and progression of AMD in people aged 75 years or older to the group of people in 43–54 years. The incidence…

Signs and symptoms of age-related macular degeneration

Undetectable and detectable signs of early AMD Age-related macular degeneration (AMD) encompasses a spectrum of clinical signs ranging from undetectable to overly manifested macular disorder. The funduscopically undetected signs may overlap with the aging changes of macula. The aging changes of macula were not systemically studied in vivo until the advent of optical coherence tomography (OCT) in recent decades. The availability of a new generation of OCT…

Classification of age-related macular degeneration

AMD classification based on drusen and pigmentary changes before OCT era Understanding the nature and developing effective treatments for age-related macular degeneration (AMD), a consensus classification for defining this leading cause of blindness in the elderly is imperative. First, AMD is a spectrum macular disorder covering both the early and late stages of the disease with a wide range of clinical signs and symptoms. Before optical…

Epidemiology of age-related macular degeneration

Prevalence and incidence Numerous population-based studies of age-related macular degeneration (AMD) have been reported around the world. AMD is the leading cause of irreversible blindness of the elderly worldwide. The reported prevalence of AMD, which varies regions, populations, and disease definitions, is constantly updating. In 2014, a systemic review and meta-analysis established worldwide prevalence and projected the number of people with AMD from 2020 to 2040.…

Overview and definition of age-related macular degeneration

Age-related macular degeneration as a leading cause of blindness among the elderly population Age-related macular degeneration (AMD) is the leading cause of irreversible blindness of the elderly worldwide. Based on the Global Vision Database, among the global population, the cause for blindness due to AMD in 1990 and 2010 was 5% and 7%, respectively. In the United States, the number of persons having AMD will increase…

The Effects of Visual Deprivation After Infancy

Introduction Blind individuals tend to show better performance than sighted individuals on a variety of auditory and tactile tasks. This is thought to be due both to compensatory hypertrophy – enhanced neuronal processing within auditory and somatosensory cortices, and to cross-modal plasticity – whereby regions of occipital cortex that normally only process visual information begin to process auditory and tactile stimulation. While there is an extensive…

Developmental Visual Deprivation

The vision of newborn infants is crude. As infants experience the normal visual environment, their vision rapidly improves with different visual capabilities emerging at different ages. Determining the exact timing for the behavioral onset of specific visual functions and identifying the critical factors that limit their development have been the primary focus of perceptual and physiological studies on vision development. Although immaturities of the physiological optics…

Development of Retinogeniculate Projections

The dorsal lateral geniculate nucleus of the thalamus (dLGN) is the gateway through which visual information is transmitted from the retina to the cortex; therefore, visual perception relies on the ability of dLGN neurons to faithfully relay the specific features of the visual world that are encoded by the retina. Accordingly, the connections between retinal ganglion cells (RGCs) and dLGN neurons are highly precise and organized.…