The eye is regarded as an immune privileged site. Since the presence of a vasculature would impair vision, the vasculature of the eye is located outside of the central light path. As a result, many regions of the eye evolved mechanisms to deliver immune cells to sites of dysgenesis, injury, or in response to the many age-related pathologies. While the purpose of these immune responses is reparative or protective, cytokines released by immune cells compromise visual acuity by inducing inflammation and fibrosis. The response to traumatic or pathological injury is distinct in different regions of the eye. Age-related diseases impact both the anterior and posterior segment and lead to reduced quality of life and blindness. Here we focus attention on the role that inflammation and fibrosis play in the progression of age-related pathologies of the cornea and the lens as well as in glaucoma, the formation of epiretinal membranes, and in proliferative vitreoretinopathy.

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A lawsuit filed in federal court in Atlanta, Georgia, in February 1982 by two private ophthalmologists and seven prospective patients charges a group of academic physicians with attempting to monopolize radial keratotomy, a surgical procedure for correcting myopia, by labeling it experimental and urging restraint in its use. The parties have agreed to a settlement involving a payment of $250,000 by the defendants and a statement that the procedure is effective in qualified patients and should no longer be considered experimental. A second suit, brought by nine physicians in federal court in Chicago in June 1984, accuses the American Academy of Ophthamology of attempting to control the procedure. The broader issue at stake is how new surgical prdocedures should be evaluated before they are brought into widespread use. In the case of radial kerototomy, a large-scale clinical trial funded by the National Eye Institute is proceeding as planned despite the legal controversy.