28 - Age-Related Macular Degeneration

Question 1

Classified as ___ or ___

Answer 1

dry or wet

Question 2

Describe Dry AMD

Answer 2

-drusen (white-yellow spots in central retina)

Question 3

Describe Wet AMD

Answer 3

• responsible for the vast majority of severe vision loss, always occurs in the setting of pre-existing dry AMD
• wet form is caused by presence of a choroidal neovascular memrane (CMV)

Question 4

What are some risk factors for losing vision?

Answer 4

• smoking
• HTN
• family Hx
• light pigmentation of the skin and irides

Question 5

What is the gold standard for investigating AMD

Answer 5

fluorescin angiography

Question 6

Non-pharms?

Answer 6

quit smoking

maintain a balanced diet

Question 7

Pharmacologic Tx:

Describe the VEGFs and how they work (vascular endothelial growth factor inhibitors)

Answer 7

-decrease vision loss in wet AMD, they inhibit growth and cause regression of new blood vessels in CNV membranes

Question 8

Pharmacologic Tx:

How are VEGFs administered?

Answer 8

-injected directly into the vitreous cavity of the eye following application of topical anesthesia and antiseptic eye drops, usually povidone-iodine

Question 9

Pharmacologic Tx:

What are the 4 VEGF examples in Canada?

Answer 9

• ranibizumab (HC approved)
• bevacizumab (off label for wet AMD and also used for colon cancer)
• afilbercept
• pegaptanib (not shown actual improvement in vision so rarely used)

Question 10

Pharmacologic Tx:

How often and for how long do you give VEGFs

Answer 10

• administer every 4 weeks

- most patients require 1 year or more of therapy

Question 11

Pharmacologic Tx:

Example of PDT (photodynamic therapy)

Answer 11

verteporfin

Question 12

Pharmacologic Tx:

How is verteporfin administered?

Answer 12

IV followed by a low level nonthermal laser light

Question 13

Pharmacologic Tx:

s/e of verteporfin (PDT)

Answer 13

• visual disturbances

- will be sensitive to light for 48 hours after

Question 14

Formulas of AREDS containing beta-carotene may increase risk of ____ cancer

Answer 14

lung

Question 15

Lutein 5 mg = _______ 250 mcg

Answer 15

zeaxanthin

Question 16

Take AREDS w food to decrease nausea that may be associated w ____ dose

Answer 16

zinc

Question 17

AREDS causes a ____ reduction of AMD-associated vision loss over 7 years

Answer 17

25%

Question 18

Describe the treatment/recommendation for Dry AMD

Answer 18

• supplement w AREDS
• quit smoking
• self-monitor w Amsler Grid (keep 33cm from face, adequate lighting)

Question 19

Describe the treatment/recommendation for Wet AMD

Answer 19

• supplement w AREDS
• quite smoking
• self-monitor w Amsler Grid (keep 33cm from face, adequate lighting)
• Retinal specialist to consider VEGF inhibitor
• For rare forms of wet AMD - may use verteporfin (PDT)

Question 20

Many patients w AMD also develop _______

Answer 20

depression

Question 21

What would be the reaction with PDT (verteporfin) and tetracyclines?

Answer 21

both cause photosensitivity