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Year 4 Ophthalmology > Age Related Macular Degeneration > Flashcards

Age Related Macular Degeneration Flashcards

1
Q

Age-related macular degeneration

A

Degeneration in the macula that causes a progressive deterioration in vision

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2
Q

Types of macular degeneration

A

Dry - 90%

Wet - 10% (worse prognosis)

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3
Q

Fundoscopy findings for macular degeneration

A

Drusen

Hypo/hyperpigmentation of retina

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4
Q

Drusen

A

Yellow deposits of proteins and lipids that appear between the retinal pigment epithelium and Bruch’s membrane

Larger and greater numbers of drusen can be an early sign of macular degeneration

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5
Q

Normal drusen

A

Small (< 63 micrometres) and hard

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6
Q

Features of AMD

A

Drusen
Atrophy of the retinal pigment epithelium
Degeneration of the photoreceptors

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7
Q

Wet AMD

A

Development of new vessels growing from the choroid layer into the retina - choroid neovascularization

Vessels can leak fluid or blood and cause oedema and more rapid loss of vision.

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8
Q

What chemical simulates the growth of blood vessels in the choroid layer

A

Vascular endothelial growth factor (VEGF)

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9
Q

Risk factors for AMD

A
  • Age
  • Smoking
  • White or Chinese ethnic origin
  • Family history
  • Cardiovascular disease
  • Light iris
  • Hyperopia - long sighted
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10
Q

Presentation for AMD

A

Gradual worsening central visual field loss

Reduced visual acuity

Crooked or wavy appearance to straight lines

Loss of contrast sensitivity and abnormal dark adaptation

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11
Q

Presentation of wet AMD

A

Presents more acutely

Loss of vision over days and progress to full loss of vision over 2-3 years.

It often progresses to bilateral disease

Central scotomas

Wavy lines

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12
Q

Examination for AMD

A

Snellen chart - Reduced acuity

Scotoma (a central patch of vision loss)

Amsler grid test -assess the distortion of straight lines

Fundoscopy - Drusen and global atrophy

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13
Q

Investigations for MD

A

Slit-lamp biomicroscopic fundus examination - diagnostic

Optical coherence tomography

Fluorescein angiography

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14
Q

Optical coherence tomography

A

is a technique used to gain a cross-sectional view of the layers of the retina. It can be used to diagnose wet AMD.

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15
Q

Fluorescein angiography

A

Giving a fluorescein contrast and photographing the retina to look at the retinal blood supply

Shows oedema and neovascularisation.

2nd line to diagnose wet AMD if optical coherence tomography does not exclude wet AMD.

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16
Q

Management of AMD

A

Refer suspected cases to an ophthalmologist for assessment and management.

17
Q

Dry AMD management

A

No specific tx

Self monitor - Amsler grid

Lifestyle measures may slow the progression:

  • Avoid smoking
  • Control blood pressure
  • Vitamin supplementation
18
Q

Wet AMD management

A

Anti-VEGF medications - ranibizumab, bevacizumab and pegaptanib

19
Q

VEGF blockers features

A

Injected directly into the vitreous chamber of the eye once a month.

Slow and reverse the progression of the disease.

Typically need to be started within 3 months to be beneficial

20
Q

Early AMD

A

Few medium sized drusens

Pigment abnormalities

21
Q

Intermediate AMD

A

1+ large drusens or several medium drusens

Geographical atrophy that does not extend to the macular centre

22
Q

Advanced dry AMD

A

Drusen and geographical atrophy extend to the macular centre

Gradual vision loss

23
Q

Why do drusens occur

A

Undigested cellular debris from the degeneration of RPE cells as apart of the normal ageing process

24
Q

What can soft drusens do

A

Lift the RPE away from the Bruch’s membrane which can cause hypoxia and inflammation leading to choroid neovascularisation and therefore wet AMD

25
Q

Progression from dry AMD to wet AMD

A
  1. Drusen formation
  2. Inflammation
  3. Macrophage recruitment
  4. VEGF secreted causing a signalling cascade
  5. Neovasularisation - Wet AMD
26
Q

Geographical atrophy

A

Advanced map like area of atrophy extending to the foveal centre

27
Q

Why does neovascularisation cause vision loss

A
  1. VEGF stimulates new blood vessels to extend through Bruch’s membrane
  2. Fluid and blood leaks beneath and into the retina
  3. Formation of fibrous scar tissue
  4. Central vision loss
28
Q

Disciform scar

A

Disc like scar - causes a scotoma

29
Q

Risk factors for the development of wet AMD

A

5+ drusens
Large soft drusens
Pigment clumping in the RPE
Systemic HTN

30
Q

Fundoscopy changes for wet AMD

A

Exudate

Blood

Elevation of the retina - due to blood, fluid or fibrovascualr tissue

Cystic oedema of the sensory retina overlying choroid neovascularization

31
Q

Charles Bonnet syndrome

A

Visual hallucinations - brain doesn’t receive as much visual stimulus therefore fills in gaps

Year 4 Ophthalmology (27 decks)

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