Age Related Macular Degeneration

Question 1

What is age related macular degeneration

Answer 1

Gradual, painless, irreversible usually bilateral central viison loss
*irreversible destruction of the macula
*incidence increases with each decade over the age of 50

Question 2

What are some RF of age-ratted macular degeneration

Answer 2

1. Age >50 (prominent RF)
2. Drusen hard or soft (hallmark)
3. Female
4. Hyperopia

Question 3

What can reduce the risk of developing AMD

Answer 3

Smoking cessation
*reduced by 30%

Question 4

What is the pathophysiology behind AMD

Answer 4

Chronic changes in the retina and retinal pigment epithelium mediated by environmental and genetic factors
*build up of free oxygen radicals creates a chronic inflammatory response
*leads to degeneration of retina (central vision loss)

Question 5

What are early changes of AMD

Answer 5

1. No vision issues
2. May be able to see Drusen fundoscopic all

Question 6

What is atrophic AMD (dry)

Answer 6

MC
1. Degeneration of macular, outer retina, pigment, and choroidal layer
2. Accumulation of small, yellow deposits of Drusen

Question 7

What type of vision loss happens with atrophic (dry) AMD

Answer 7

1. Gradual, bilateral central vision loss

Question 8

How is atrophic AMD (dry) categorized

Answer 8

1. Early
2. Intermediate
3. Advanced / late

Question 9

What is neovasuclar AMD (wet/ exudative)

Answer 9

Neovascular vessels grow in choroid space beneath retina
1. New but weak and fragile
2. Vessels leak: retinal detachment, disc edema
3. Large soft Drusen

Question 10

What type of vision loss does neovascular AMD (wet) cause

Answer 10

Sudden bilateral central vision loss

Question 11

How is neovascular (wet) AMD categorized

Answer 11

1. Advanced
2. Exudative

Question 12

What are the symptoms of atrophic (dry) AMD

Answer 12

1. Painless
2. Gradual blurred vision
   *decreased ability to see fine details
3. Haziness
4. Blurred / blind spot
   *central vision loss becomes larger, darker

Question 13

What are the signs of neovascular (wet) AMD

Answer 13

1. Painless
2. Vision loss is rapid,severe, occurs suddenly
3. Metamorphosia
   *wavy appearance of straight lines (accumulation of fluid hemorrhage)

Question 14

What will be seen on PE for atrophic (dry) AMD

Answer 14

1. Intact peripheral vision
2. Discrete yellow hard Drusen bodies
3. Sharply defines clustered in macular area

Question 15

What will be found on PE for neovascular (Wet) AMD

Answer 15

1. Intact peripheral vision
2. Large confulent soft Drusen bodies, less distant borders

Question 16

What is the treatment of age related macular degeneration

Answer 16

1. Lifestyle changes, smoking cessation, sunglasses
2. No specific medical treatment to resolve / stop but can control

Question 17

What can reduce a patients risk of progressing to advanced AMD (dry, atrophic)

Answer 17

Nutritional supplements
1. Zinc
2. Vitamin C & E
3. Cooper
4. Folic acid
5. Vitamins B6 and B12
*no vitamin A

Question 18

How should someone monitor their AMD?

Answer 18

Annual ophthalmologist exams
*amsler grid

Question 19

What is the treatment for wet (neovascular) AMD

Answer 19

1. Bevacizumab
2. Long term repeated intraocular injections several times a year or even monthly

Question 20

What is the prognosis of AMD

Answer 20

Depends on type and severity
1. Regular follow ups
2. number of eyes involved is a big factor of prognosis

Question 21

What is the goal of treatment for AMD

Answer 21

Reduce risk of progression
*dry AMD to wet AMD