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To the Editor: Dr Seddon and colleagues¹ reported that C-reactive protein is significantly associated with intermediate and advanced stages of age-related macular degeneration (AMD), independent of established risk factors such as obesity and smoking. The authors concluded that inflammation may have a role in the pathogenesis of AMD and suggested that anti-inflammatory agents might be used in preventing AMD.

This is not a new hypothesis. I am concerned that Seddon et al did not cite several previous studies in this area. We recently published a review² that cites evidence of both cellular and humoral factors in AMD.^3-4

Similarly, anti-inflammatory agents have been used for AMD in clinical trials since 1995.⁵ Several studies have investigated the use of anti-inflammatory agents, either alone^6-7 or combined with other therapies such as photodynamic therapy,⁸ to treat AMD.

Philip L. Penfold, PhD
ppenfold@eye.usyd.edu.au
CCLRU/Vision CRC
University of New South Wales
Sydney, Australia

1. Seddon JM, Gensler G, Milton RC, Klein ML, Rifai N. Association between C-reactive protein and age-related macular degeneration. JAMA. 2004;291:704-710. FREE FULL TEXT 2. Penfold PL, Madigan MC, Gillies MC, Provis JM. Immunological and aetiological aspects of macular degeneration. Prog Retin Eye Res. 2001;20:385-414. FULL TEXT | ISI | PUBMED 3. Penfold PL, Provis JM, Furby JH, Garenby PA, Billson FA. Autoantibodies to retinal astrocytes associated with age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol. 1990;228:270-274. FULL TEXT | ISI | PUBMED 4. Chen H, Wu L, Pan S, Wu DZ. An immunologic study on age-related macular degeneration. Yan Ke Xue Bao. 1993;9:113-120. PUBMED 5. Penfold PL, Gyory JF, Hunyor AB, Billson FA. Exudative macular degeneration and intravitreal triamcinolone: a pilot study. Aust N Z J Ophthalmol. 1995;23:293-298. ISI | PUBMED 6. Jonas JB, Kreissig I, Hugger P, Sauder G, Panda-Jonas S, Degenring R. Intravitreal triamcinolone acetonide for exudative age related macular degeneration. Br J Ophthalmol. 2003;87:462-468. FREE FULL TEXT 7. Wong D, Campbell I, Groenwald C, Lancaster E. Intravitreal triamcinolone acetonide for exudative age related macular degeneration. Br J Ophthalmol. 2004;88:598. FREE FULL TEXT 8. Rechtman E, Danis RP, Pratt LM, Harris A. Intravitreal triamcinolone with photodynamic therapy for subfoveal choroidal neovascularisation in age related macular degeneration. Br J Ophthalmol. 2004;88:344-347. FREE FULL TEXT

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;292:43.

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Inflammation and Age-Related Macular Degeneration—Reply
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JAMA. 2004;292(1):43.
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Association Between C-Reactive Protein and Age-Related Macular Degeneration
Johanna M. Seddon, Gary Gensler, Roy C. Milton, Michael L. Klein, and Nader Rifai
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