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Background To assess the effect of switching patients previously incompletely treated with ranibizumab (RBZ) to aflibercept (AFL) using a pro re nata (PRN) treatment strategy in neovascular age-related macular degeneration (nvAMD). Methods A retrospective case series was conducted on patients who had persistent or recurrent intra- and/or sub-retinal fluid treated initially with RBZ and subsequently switched to AFL. The main outcome measures were best corrected visual acuity (BCVA) and central retinal thickness (CRT) measured at different stages of the study. Friedman analysis of variance and Wilcoxon test were used to examine differences in BCVA and CRT. Results Two hundred and seven eyes from 182 patients were included. BCVA and CRT improved significantly initially following 3 RBZ injections with a mean gain of 3.7 letters (p

Aims: To investigate relative priorities in quality of life (QoL) in patients with age related macular degeneration (AMD). Methods: Measures of visual function, quality of life (QoL) and utility associated with visual loss were obtained from 122 patients with AMD classified according to macular morphology. The two methods of utility assessment were time trade-off (TTO) and conjoint analysis (CA) which have been recommended by the United Kingdom9s National Institute of Clinical Excellence (NICE) as techniques for the assessment of health care priorities. Results: Results show that the two methods for assessing utility are poorly related; TTO relates moderately to visual function and disease severity but CA does not. CA identified two different subgroups of patients, one with outdoor mobility and the other with reading as their main priority. Conclusion: Further work is needed and caution required interpreting data obtained using these methodologies for determining relative importance in vision related QoL studies.

Aims: (1) A prospective study to assess visual function measures and quality of life (QoL) in patients with wet age related macular degeneration (AMD) treated with photodynamic therapy (PDT). (2) To assess if PDT prevents severe visual loss (loss of six or more lines of distance visual acuity) in the treated eye. Methods: 48 of 51 recruited patients with predominantly classic subfoveal choroidal neovascularisation (CNV) secondary AMD who were treated with PDT were followed up for 1 year. Assessment included distance and near visual acuity, contrast sensitivity, vision related quality of life and fluorescein angiography. Photodynamic therapy using Visudyne was carried out according to standard protocol. Patients were followed up every 3 months and treatment repeated if there was significant leakage from CNV. Results: At the 12 month follow up, 71% (n = 34) of the patients lost less than three lines of best corrected distance visual acuity. Although there were significant decreases in some of the QoL items tested, patients were significantly less anxious and more independent outdoors at the 12 month follow up. Conclusion: This study is in keeping with published literature with PDT preventing severe visual loss in two thirds of treated patients with predominantly classic CNV.

PURPOSE In this case-control study, the hypothesis that factor H autoantibodies are associated with age-related macular degeneration (AMD) was examined. METHODS One hundred AMD patients (median age, 78 years), 98 age-matched control subjects (median age, 78 years) known not to have AMD, and 100 healthy blood donors (median age, 43 years) were enrolled. An enzyme-linked immunosorbent assay (ELISA) was used to screen for complement factor H autoantibodies and either quantitative polymerase chain reaction (qPCR) or multiplex ligation-dependent probe amplification (MLPA) were performed to measure the copy number of the gene encoding complement factor H-related protein 3 (CFHR3). RESULTS There was a significant difference in the median complement factor H autoantibody titer between the three groups (AMD patients, 196 reference units [RU]]; age-match control subjects, 316 RU; and blood donor control subjects, 121 RU; Kruskal-Wallis test, P < 0.001). Pair-wise comparison (Mann-Whitney test) showed that all three groups were significantly different from each other. Two different thresholds were used in the healthy blood donors to identify individuals with complement factor H autoantibodies. Both suggested that the prevalence of factor H autoantibodies was decreased in AMD patients. The CFHR3 copy number was measured as a surrogate for the deletion of the genes encoding complement factor H-related proteins 3 and 1 (CFHR3/1). The allele frequency of the deletion was significantly higher in the age-matched control subjects than in the AMD patients (22.2% vs. 8.2%). CONCLUSIONS The level of factor H autoantibodies is lower in AMD patients than in age-matched control subjects.

Age-related macular degeneration (AMD) is the commonest cause of blindness in the population over 60 years of age and accounts for over 50% of those registered blind in the UK. The incidence is increasing and as older generations live longer a growing number of patients will be affected in the future. Affected patients lose central vision, important in all aspects of everyday life. This review outlines risk factors for AMD, clinical features, treatment and management strategies for patients, families and physicians caring for those with AMD. Recent trials are included along with practical clinical advice. While there is no curative treatment at present, intervention can reduce the risk of developing AMD and limit disease progression if it occurs. These modalities are discussed here. As new discoveries in the field of genetics and novel therapies emerge, a brighter future seems certain for the ageing population.

Editor,—The key to successful age related macular degeneration (ARMD) screening is the efficient production of accurate classified images with minimum patient inconvenience.1 The technologies of digital image analysis and artificial neural networks (ANN) are not new and have been used in the past to provide a more objective basis for a range of medical applications.2-9They have, however, not been used for operational classification of maculopathies such as ARMD. Research has shown that ANN computer programs are capable of discriminating normal fundus from those with diabetic retinopathy, potentially reducing the numbers of images requiring expert examination by 70% or more.10 Digital fundus images from a Topcon Imagenet camera were modified by in-house computer imaging techniques (erdas Imagine Software) within a geographical information system (GIS) (Fig 1). The ANN used …

AIMS—To determine whether patients with age related macular degeneration (ARMD) benefit from cataract surgery in terms of visual function and quality of life measures, and to assess the impact of surgery on the progression of ARMD. METHODS—A prospective study was carried out of patients with and without ARMD undergoing cataract surgery. Data were collected from 187 patients at the Princess Alexandra Eye Pavilion, Edinburgh and the Oxford Eye Hospital, Oxford. The patients were divided into three groups: (1) a control group with ARMD and no surgery (n=41), (2) a study group of patients with ARMD who underwent cataract surgery (n=90), and (3) a second control group of patients without ocular comorbidities who underwent cataract surgery (n=56). Visual function and quality of life assessments were carried out at baseline and 3-5 months after baseline or surgery. RESULTS—There were significant improvements both in terms of quality of life and visual function measures in the study group. Benefits were greater in patients with moderate cataract irrespective of the degree of ARMD. No increased incidence in progression to the "wet" form of ARMD was found. Improvements in quality of life measures and visual function were more pronounced in patients with no ocular comorbidities. CONCLUSIONS—Patients with mild and moderate degrees of ARMD do benefit from cataract surgery and the benefits are greater in patients with moderate degrees of lens opacity. Longer follow up is required to assess the risk of increased ARMD progression.

The compounds Me3SnCCl3, Me3SnCCl2H, Me3SnCCl2Ph and Me3SnCCl2-Me have been prepared by reaction of the appropriate organolithium reagent with trimethyltin chloride at low temperature. The reaction of phenyl(bromodichloromethyl)mercury with trimethyltin bromide in refluxing benzene solution produced Me3SnCCl2Br in 63% yield. An experiment in which this mercury reagent was allowed to react with trimethyltin chloride gave both Me3SnCCl3 and Me3SnCCl2Br, which suggests that this route to trihalomethyl-tin compounds proceeds both by CCl2 insertion into the SnX bond and by substituent exchange between mercury and tin.

The low temperature reactions of n-butyilithium with trimethyl(dichloromethyl)silane and bis(trimethylsilyl)dichloromethane have served in the preparation of trimethylsilyldichloromethyllithium and bis(trimethylsilyl)chloromethyllithium, respectively, in high yield. Reactions of these reagents with trimethyltin chloride, trimethylchlorosilane, mercuric halides and methyl iodide are described.

The preparation of trimethyltindichloromethyllithium by reaction of bis(trimethyltin)dichloromethane with n-butyllithium, of trimethyltinbromochloromethyllithium by reaction of bis(trimethyltin)bromochloromethane with n-butyllithium and of trimethyltindibromomethyllithium by reaction of trimethyl(tribromomethyl)tin or bis(trimethyltin)dibromomethane with n-butyllithium is described. All of these new lithium reagents are stable in THF-rich media only at low temperatures (−95° or below). Their reactions with trimethylchlorosilane are complicated by the fact that at such low temperatures the product, trimethylsilyl(trimethyltin)dihalomethane, is comparable in reactivity toward the lithium reagent with trimethylchlorosilane. Similar complications occur with other quenching agents such as methyl iodide.