a smaller fragment, fab fragment, of the parent bevacizumab molecule specifically designed for eye injections. other approved antiangiogenic drugs for the treatment of neo-vascular amd include pegaptanib and aflibercept. these anti-vegf agents may be administered monthly or adaptively. for adaptive anti-vegf treatment, two approaches are conventionally applied. in the case of pro re nata, the patient comes at fixed intervals, but treatment is only administered if an activity is detected (i.e., presence of fluid). in the case of treat-and-extend, the patients always receive treatment, but the interval to the next visit is extended if the lesion was inactive. recently, researchers have started to apply ai algorithms to predict the future need for treatment. but these approaches have not been validated for clinical use as of today. the american academy of ophthalmology practice guidelines do not recommend laser coagulation therapy for macular degeneration, but state that it may be useful in people with new blood vessels in the choroid outside of the fovea who don't respond to drug treatment. there is strong evidence that laser coagulation will result in the disappearance of drusen but does not affect choroidal neovascularisation. a 2007 cochrane review on found that laser photocoagulation of new blood vessels in the choroid outside of the fovea is effective and economical method, but that the benefits are limited for vessels next to or below the fovea. photodynamic therapy has also been used to treat wet amd. the drug verteporfin is administered intravenously; light of a certain wavelength is then applied to the abnormal blood vessels. this activates the verteporfin destroying the vessels. cataract surgery could improve visual outcomes for people with amd, though there have been concerns about surgery increasing the progression of amd. a randomized controlled trial found that people who underwent immediate cataract surgery (within two weeks) had improved visual acuity and better quality of life outcomes than those who underwent delayed cataract surgery (6 months). radiotherapy has been proposed as a treatment for wet amd but the evidence to support the use of modern stereotactic radiotherapy combined with anti-vegf is currently uncertain and is awaiting the results of ongoing studies. nucleoside reverse transcription inhibitors like they are used in anti-hiv therapy was associated with a reduced risk of developing atrophic macular degeneration. this is because alu elements undergo l1 (protein)-mediated reverse transcription in the cytoplasm resulting in dna synthesis. first clinical trials are being prepared as of january 2021. adaptive devices josef tal, an israeli composer who was affected by macular degeneration, checks a manuscript using a cctv desktop unit. because peripheral vision is not affected, persons with macular degeneration can learn to use their remaining vision to partially compensate. assistance and resources are available in many countries and every state in the u.s. classes for "independent living" are given and some technology can be obtained from a state department of rehabilitation. adaptive devices can help people read. these include magnifying glasses, special eyeglass lenses, computer screen readers, electronic glasses, and tv systems that enlarge the reading material. computer screen readers such as jaws or thunder work with standard windows computers. also, apple devices provide a wide range of features (voice-over, screen readers, braille etc.). video cameras can be fed into standard or special-purpose computer monitors, and the image can be zoomed in and magnified. these systems often include a movable table to move the written material. accessible publishing provides larger fonts for printed books, patterns to make tracking easier, audiobooks and daisy books with both text and audio. epidemiology disability-adjusted life year for macular degeneration and other (sense organ diseases) per 100,000 inhabitants in 2004 no data less than 100 100–114 114–128 128–142 142–156 156–170 170–184 184–198 198–212 212–226 226–240 more than 240 the prevalence of any age-related macular degeneration is higher in europeans than in asians and africans. there is no difference in prevalence between asians and africans. the incidence of age-related macular degeneration and its associated features increases with age and is low in people <55 years of age. smoking is the strongest modifiable risk factor. as of 2008, age-related macular degeneration accounts for more than 54% of all vision loss in the white population in the us. an estimated 8 million americans are affected with early age-related macular degeneration, of whom over 1 million will develop advanced age-related macular degeneration within the next 5 years. in the uk, age-related macular degeneration is the cause of blindness in almost 42% of those who go blind aged 65–74 years, almost two-thirds of those aged 75–84 years, and almost three-quarters of those aged 85 years or older. research association with other age-related diseases studies indicate drusen associated with amd are similar in molecular composition to amyloid beta (aβ) plaques and deposits in other age-related diseases such as alzheimer's disease and atherosclerosis. this suggests that similar pathways may be involved in the etiologies of amd and other age-related diseases. genetic testing genetic testing can help identify whether a patient with amd is at a greater risk of developing the condition and can inform disease progression. genetic testing can also allow researchers to identify whether patients are more or less likely to respond to treatments, such anti-vegf medication or complement inhibitors. however, there remain several challenges to using predictive tools which incorporate genetic variation in clinical practice. as well as our limited understanding of the way that different genetic variants and environmental factors interact to influence amd risk, the single nucleotide polymorphisms which are common in the population have small effects on individual patients with amd. therefore, there is increasing interest in understanding the functional consequences of rare mutations, which often have more pronounced effects. genetic testing to guide clinical management is not currently recommended. stem cell transplant