New treatments for age-related macular degeneration/Authors' reply

The prohibitive costs might have resulted in the recent conclusion by the UK's National Institute for Health and Clinical Excellence (NICE) that pegaptanib is not cost effective and that ranibizumab might be, but only for the better eye in patients with both eyes affected (July 21, p 194).1 Considering that some of the breakthrough therapies yield only marginal visual dividends,2 our approach to combating blindness from AMD in this rapidly ageing world should include possible preventive strategies to tackle modifiable risk factors. A carotenoid-rich diet reduces the risk of AMD,4 and the use of high-dose antioxidant supplements to prevent progression of moderate to advanced AMD has been shown to be a reasonable investment of health resources compared with other treatments for AMD.5 While we debate on how best to fund the rising treatment costs of wet AMD, let us not neglect the huge potential public-health benefits of preventive strategies such as quitting smoking and dietary modification.