6.1.9 Manages Macular Degeneration

Question 1

what is amd?

Answer 1

Age related macula degeneration

Question 2

what is the bruchs memebrane?

Answer 2

this si the basement between the retinal pigment epithelium and the choioid

bruchs memebrane maintains a micorenviorment for the photoreceptors

when the bruch memebrane thickens = casues issiues

Question 3

what is the need of bruchs membrane?

Answer 3

1. barrier between the retina and the choid - waste + nutrient management
2. Support - structural support to the RPE

Question 4

what happens to bruchs membrane as get older?

Answer 4

1. It gets thicker and not as permeable as it used to be –> less nutrients!
   2.

Question 5

Why is drusen a sign of dry amd?

Answer 5

debris between the bruchs membrane and the rpe - lipids, proteins, zinc –> no cleared properly.

hard = smaller + defined
soft = larger + less defined

Question 6

What is focal pigmentation?

Answer 6

When the rpe becomes damaged it tries to repair itself –> this makes the rpe cells larger –> this will make them more pigmented

SIGN OF STRESS

Question 7

What is geographic atrophy of the rpe?

Answer 7

Advanced amd –> degeneration and loss of RPE cells

metabolic burden / oxidative stress of the rpe = cannot support the photorecptors = they die

Question 8

what does geographic atrophy look like?

Answer 8

it will be sharply defined areas of depigmentation - can see the sclera and choroidal BV as it is thin

Question 9

Dry amd management?

Answer 9

no medical treatment

nutriental supplements - areds 2 study
no smoking + balanced diet

LOW vision services

Question 10

what is wet amd?

Answer 10

choroidal neovascularization

classic = on top of the rpe - prognois is more poor as not restriction
occult = below - rpe will limit the speed of growth

Question 11

what causes a risk of wet amd?

Answer 11

soft drusen

Question 12

why do you get subretinal hemorrhage?

Answer 12

abnormal BV from chorid breaks through the bruchs memebrane - leak

Question 13

why can we get subretinal exudates?

Answer 13

the same leaky bv form the choroid will leake out protiens, lipids –> exudates

Question 14

classic CNV..

Answer 14

well defined on fluorescien angiography –> bright
under the sensory retina but above the rpe

this proggresses quicker then occult, Aggresive –> prognosis is poor if not addressed promptly.

Question 15

occult cnv ..

Answer 15

1. less distinct on fluoresciene angiography -> faint + poorly defined and under the rpe later = harder to see

under rpe = less aggresive leakage

harder to detect and harder to treat but it is slower in progression

Question 16

WET amd generic treatement

Answer 16

1. counselling in clinic
2. Liasion officer
3. Low vision service + advice
4. Reg as si/ssi
5. Macula society

Question 17

what is photodynamic treatement for WET amd?

Answer 17

1. Verteporfin is a photosensitizing agent which is injected -> cirulates around the body
2. 10 mins given to concentrate in abnormal BV –> laser shone into px eye
3. Reactive oxygen species damage the endothelial cells in the Abonroaml blood vessel = close
4. vessel is occluded and stops leaking

Normally need more then one session as not all abnormal vessels may be destoryed in the first one

Question 18

who is suitable for photodynamic treatement?

Answer 18

6/60 or better

Classiic Chorico neovas

Question 19

What is antivegf treatement?What anti-vegf are there?

Answer 19

1. lucentis
2. Avastin

Question 20

How is lucentis used?

Answer 20

0.5mg of intravitreal injeciton over 3 months… improves visions.

Approved by nice

exlusion if VA is very poor, if the lesion size is toooo big

Question 21

What are complicaitosn with intra-vitrous injections?

Answer 21

1. endophalmitis
   CAT
   RD
   increased IOP

Question 22

What about avastin?

Answer 22

This has a half life longer then lucentisi –> equally as effective and cheaper

Question 23

what are the diffrent types of amsler?

Answer 23

1. nromal
2. diagnoal lines help with scotomas
3. red on black - colour scotomas
4. no lines - for scotomas not distotion
5. horizotnal lines only = metamorphopisa
   6+7 - central indepth assessment

Question 24

stages of amd

Answer 24

no aging
normal - druplets smaller thrn 63
early amd = bigger then 63 smaller then 125
intermediate larger then 125 + pig chnages
late = wet / scar