Friday, March 10, 2006

AMD Future 127

Chapter Seven
The Future

Research into the cause and treatment for AMD is progressing rapidly. The field of molecular genetics has given us powerful tools to figure out why some people get a disease whereas others don’t. Already a number of genes associated with AMD have been discovered, and we believe that most of the rest will be discovered in the next five years. The genes are like the blueprints use by the cells to make necessary proteins or other molecules in the body. Once we know which gene (blueprint) is abnormal, we can determine what protein is made by the cells using this blueprint. Presumably this protein will also be abnormal and not function like it should, thus causing macular degeneration. So we’ll know where the weakness is, the crack in the concrete, so to speak, which leads to problems later in life. One way to prevent vision loss would be to try to strengthen the weak area.

This is already happening. For instance, the discovery of mutations in the H factor of the complement system (see Chapter 2) clearly showed that inflammation was involved in many cases of AMD. Now scientists are concentrating on inflammation and trying to figure out how to control the runaway inflammation involved in AMD.

Right now we lump all patients with AMD together when we do clinical trials. The results of any given trial are the average of all the patients in the trial. But what really happens is that some patients in the trial do spectacularly well whereas others don’t. The reason for the difference is probably that AMD is not a single disease but is made up of many diseases that look similar. The patients who do well in a particular trial may have one type of AMD, and the patients who do poorly may have another type. Therefore, the conclusions drawn from the results of the trial may help one group of AMD sufferers a lot, but do nothing or even harm other groups.

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