Macular Degeneration

Question 1

Risk factors for AMD

Answer 1

age, family history, cataract surgery, smoking, native American ancestry, HTN, diabetes, lack of regular exercise (<3x a week)

Question 2

What is AREDS1

Answer 2

No AMD

• Normal signs of again
• No - few small drusen <63um.
• 15% conversion to intermediate AMD within 10 years

Question 3

What is AREDS2

Answer 3

Early AMD

• Combination of:
  o Multiple small drusen
  o Few intermediate drusen (63-124um)
  o Mild RPE abnormalities
• 15% conversion to intermediate AMD within 10 years

Question 4

What is AREDS3

Answer 4

• Many intermediate drusen
• ≥1 large drusen (>125 um)
• Geographic atrophy

Question 5

What is AREDS4

Answer 5

• Geographic atrophy (involving foveal centre) - requires FA to exclude other inherited retinal disease.
• Neovascularisation maculopathy: CNV, hard exudates, subretinal and sub RPE fibrovascular proliferation

Question 6

AREDS1 Management

Answer 6

Management: Observation only.

Question 7

AREDS2 Management

Answer 7

1. Observation only
2. Regular exercise (≥3x/week)
3. Cease smoking.

Question 8

AREDS3 Management

Answer 8

1. Dietary Advice
   a. Dark green leafy vegetable daily
   b. Oily fish 2 – 3 x a week
   c. Low GI carbohydrates
   d. Handful of nuts weekly
   e. Limit consumption of saturated fats/oils
2. Regular exercise (≥3x/week)
3. Cease smoking.
4. Daily supplements:
   a. 500mg vitamin C
   b. 400IU vitamin E
   c. 15 mg Beta – carotene OR 10mg Lutein and 2mg zeaxanthin and 25mg zinc oxide
   d. 80mg zinc oxide (if usually beta – carotene)
   e. Copper (2mg as cupric oxide)

Question 9

AREDS4 Management

Answer 9

1. Referral to ophthalmology for Anti – VEGF (ranibizumab or Aflibercept)
   a. May consider in combination with iRay radiation
   b. Risk of ischemic cardiac event (stroke), elevated IOP
2. Potential Treatment
   a. Pegcetocoplan PM or PEOM injections
   b. Aracincaptad Pegol
   c. Gene therapy – factor B antisense with RNA target

Question 10

Calculate rate of progression to late AMD

Answer 10

Right eye
Large Drusen = 1
Pigment Change = 1

Left eye
Large Drusen = 1
Pigment Change = 1

0 = 0%
1 = 3%
2 = 9%
3 = 27%
4 = 43%