Our cover focus this month, retina and the general ophthalmologist, will come as no surprise to the general ophthalmologist. Recent years have seen a sharp rise in research, product development and clinical studies in retinal disease, particularly age-related macular degeneration, and the interest figures only to intensify in the coming years.

Each passing day pushes the Pepsi Generation one step closer to becoming the macular degeneration generation. Each year sees 200,000 new cases of wet AMD, and this number is expected to increase significantly as baby boomers age and life expectancy increases. By 2030, 6.3 million people will have vision loss caused by wet AMD, and 500,000 people will lose their sight annually from the disease, according to some estimates.

The range of potential treatment options being studied for AMD, indicative of medicine's nascent understanding of the disease's possible causes, is broad and expanding. PDT, and a variety of pharmaceutical approaches occupy center stage for now, and the next few months should see approvals for one or more of these. Dr. Mary Elizabeth Hartnett provides a comprehensive survey this month on the current understanding of AMD and a review of the agents in trials today.

Despite optimism about the potential of some current treatments to halt vision loss, the near-term prospects for effective AMD treatments are not encouraging, based on a recent survey of retina specialists. As AMD's impact slowly overtakes our aging population, the health-care system may soon be flooded with demand for low vision and vision rehabilitation services, counseling and other social services.

There are big changes coming in the next few years in treating retinal disease. As they are wont to do in medicine, though, they'll likely come in small steps. Which treatment modality, or combination thereof, emerges as the best option is anyone's guess. One thing that's certain is the comprehensive ophthalmologist will have a greater responsibility in the fight against AMD. The prospects of preventing vision loss from AMD, independent of any breakthrough treatments that might emerge, will continue to rely on early detection by the patient's primary eye-care provider.