Age Related Macular Degeneration (AMD)

Last updated 20.05.13

 

Index

 

Definition

-   

 

Features

-  Leading cause of irreversible vision loss in industrialised countries

-  Associated w depression, frequent falls & impaired ADLs

-  90% Non-exudative on presentation

 

Types

-  Non-exudative

-  Exudative

 

Cause

-  Genetic & environmental factors

-  Age: 50 yrs+

-  Race

-  Family history

-  Smoking

-  HTN

-  Cataract surgery

 

Associated S/S

-  Blurred central visual acuity (macula)

-  Contrast & color disturbance

-  Delayed dark adaptation

-  Mild metamorphosia

-  Scotoma

-  Acute or insidious onset

-  Bilateral or unilateral

 

 

 

Non-Exudative AMD

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Features

-  90% pts w AMD

-  Drusen present before visual loss occurrs

-  Progresses to retinal atrophic & hypertrophic changes & loss of central vision

-  Progressive atrophy of retinal pigment epithelium = geographic atrophy --> more rapid loss of vision

-  10-20% pts progress to Exudative

 

Ix

-  Amsler Grid: central scotoma, metamorphosia

-  Dilation w fundoscopy &/or Slit lamp

-  Drusen

-  Retinal pigment epithelium hypertrophy or atrophy

-  Geographic atrophy

-  Stereo color photography of the fundus

-  Fluorescein Angiography (FA): exclude CNV

 

Drusen

 

Geographic Atrophy

 

Mx

-  Suitability for driving

-  Antioxidants

-  Limit progression to Exudative

 

 

 

Exudative AMD

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Features

-  Pathological choroidal neovascular (CNV) membranes

 

Ix

-  Amsler Grid: central scotoma, metamorphosia

-  Dilation w fundoscopy &/or Slit lamp

-  Drusen

-  Retinal pigment epithelium hypertrophy or atrophy

-  Subretinal fluid, retinal pigment epithelial detachment, subretinal lipid deposits

-  Subretinal haemorrhage --> vitreous haemorrhage

-  Stereo color photography of the fundus

-  Fluorescein Angiography (FA): CNV

-  Optical Coherence Tomography (OCT)

 

Mx

-  Suitability for driving

-  Antioxidants

-  CNV

-  Laser Photocoagulation

-  Photodynamic therapy

-  Verteporfin

-  VEGF Inhibitors

-  Pegaptanib, Ranibizumab, Bevacizumab