Sohel Somani, MD, FRCSC, Clinical Instructor, Department of Ophthalmology and Vision Sciences, University of Toronto; Associate Staff, Princess Margaret Hospital, Toronto, ON.

Age-related macular degeneration (ARMD) is a progressive disease affecting the central vision of patients older than 55 years. ARMD is classified as atrophic (dry) or exudative (wet) forms based on clinical characteristics. Management of atrophic ARMD includes vitamin supplementation with high-dose antioxidants in appropriate patients. Patients who develop exudative ARMD may be eligible for treatment depending on flourescein angiogram characteristics. Options available to close a choroidal neovascular membrane include thermal laser photocoagulation or photodynamic therapy. Other treatment modalities are currently under investigation that may lead to more therapeutic options in the future.

Key words: macular degeneration, vitamins, laser, photodynamic therapy, angiogenesis.

D'Arcy Little, MD, CCFP
Director of Medical Education,
York Community Services, Toronto, ON

Introduction and Epidemiology:
Peripheral vascular disease (PVD), a common and often disabling condition, usually results from the atherosclerotic occlusion of the arteries in the lower limbs.¹ Symptomatic PVD is rare in men before the age of 50, but prevalence increases dramatically with age. The Edinburgh Artery Study states that the prevalence of symptomatic PVD increases from 2.2% in men aged 50 to 59, to 7.7% in men aged 70 to 74.^2,3 Before the 7th decade, the prevalence in women is approximately half that seen in men, but this difference diminishes after that age.⁴

Definition and Diagnosis of Intermittent Claudication (IC)
Patients who suffer from intermittent claudication (IC) represent a subset of those patients with symptomatic lower extremity atherosclerotic disease. This review will focus on an approach to the investigation and management of this condition in the elderly population. Only 7-9% of patients with diagnosed lower extremity atherosclerosis suffer from intermittent claudication.5 In 1962, the Rose claudication questionnaire was developed as an epidemiologic instrument for the purposes of identifying patients with IC. It also serves as a good working definition of IC.

Rhonda Witte, BSc

Cancer. The word alone is enough to send fear into the hearts of people. It is safe to assume that everyone knows of someone who has been touched by cancer; they know of someone who is living with or has died of the disease. There are also people who have triumphed over the disease--they have fought cancer and won, they are survivors. Over the years, there have been numerous advances in cancer research. A hot topic in cancer research, in recent years, has focused around a process called angiogenesis. Specifically, researchers are trying to understand angiogenesis and use this knowledge to prevent the growth and spread of cancer.

Angiogenesis, also called neovascularization, is the growth of new blood vessels. Normally, the endothelial cells comprising the capillary walls do not divide. However, during pregnancy, menstruation, and wound repair, endothelial cells are stimulated to grow and divide, increasing the number of blood vessels.^1-3 During angiogenesis, endothelial cells must break through the basal lamina around the capillary wall. They do this by releasing proteases, thereby degrading the extracellular matrix. Endothelial cells then migrate toward the stimulatory signal, proliferating and aligning to form new capillaries.⁴ When properly regulated, angiogenesis stops after a short period of time.