Age Related Macular Degeneration: Gradual Vision Loss Flashcards
What is age-related macular degeneration (ARMD)?
Most common cause of blindness in the UK.
What is the pathophysiology of ARMD?
Degeneration of the central retina (macula)
Degeneration of retinal photoreceptors resulting in the formation of drusen which can be seen on fundoscopy and retinal photography
Changes usually bilateral
What are the two forms of ARMD?
Dry and Wet
What is dry ARMD?
90% of cases, geographic atrophy
Macular degeneration characterised by drusen.
What are drusen?
Yellow, round spots in Bruch’s membrane
seen in dry ARMD
What is wet ARMD?
10% of cases, exudative, neovascular
Macular degeneration, characterised by choroidal neovascularisation
Leakage of serous fluid and blood can subsequently result in a rapid loss of vision. Carries the worst prognosis
What is early ARMD?
(Similar to dry)
Non-exudative, age-related maculopathy: drusen and alterations to the retinal pigment epithelium (RPE)
What is late ARMD?
(Similar to wet)
Neovascularisation
Exudative
What is the epidemiology of ARMD?
Most common cause of visual loss in elderly persons in the developed world
Male: Female 1:2
Avg. >70 yo
What are the risk factors of ARMD?
Advancing age
Smoking (2x likely)
Family history
CVD Rfx: Hypertension, dyslipidaemia, diabetes mellitus.
What is the presentation of ARMD?
Sub-acute onset visual loss
Reduction in visual acuity (
What are the signs of ARMD?
Distorsion of line perception on Amsler grid testing
Fundoscopy: drusen (yellow pigment in macular area)
(Wet ARMD: well demarcated red patches which may represent intra-retinal or sub-retinal fluid leakage or haemorrhage)
What are the investigations of ARMD?
SLIT-LAMP MICROSCOPY (to identify pigmented, exudative or haemorrhagic changes)
COLOUR FUNDUS PHOTOGRAPHY (baseline for changes over time)
Wet: FLUOROSCEIN ANIOGRAPHY is neovascular ARMD is suspected with indocyanine green angiography.
OCULAR COHERENCE TOMOGRAPHY to visualise the retina in three dimensions
What is the treatment of dry ARMD?
(AREDS trial)
Zinc and anti-oxidant vitamins A, C and E reduce progression of the disease
(Laser photocoagulation - can be used in both)
What is the treatment of wet ARMD?
Anti - Vascular endothelial growth factor (VEGF)
Anti-VEGF can limit the progression.
Ranibizumab, Bevacizumab, Pegaptanib.
(Laser photocoagulation - can be used in both)
