Age related macular degeneration Flashcards
Classic fundoscopy finding in age related macular degeneration?
Drusen
Atrophy of the retinal pigment epithelium
What are the four layers of the macula?
Choroid - contain blood supply to the macula
Bruch’s membrane
Retinal pigment
At the top - photoreceptors that sense the light
What are drusen?
Yellow deposits of proteins and lipids that appear between the retinal pigment epithelium and Bruch’s membrane.
Key chemical that stimulates the growth of blood vessels in the eye?
Vascular endothelial growth factor (VEGF)
Target of medications that are used to treat wet AMD
risk factors for age related macular degeneration?
Old age
Smoker
White/Chinese ethnic origin
Family history
Existing cardiovascular disease
Clinical presentation of wet age related macular degeneration?
Gradually worsening central vision loss
Reduced overall visual acuity
Crooked or wavy appearance to straight lines
Wet presents more acutely and presents with loss of vision over days. Often progresses to bilateral disease
How do you examine a patient with query age related macular degeneration?
SCROLL
Central scotoma
Test visual acuity using a schnellen chart
Amsler grid test to detect wet macular degeneration
Fundoscopy - detect drusen
Slip lamp biomicroscopic fundus examination - by specialist
Optical coherence tomography (OCT) - cross sectional view of layers of retina to diagnose wet AMD
Fluoroscein angiography - reveals oedema and neovascularisation
How do you manage age related macular degeneration?
Refer to ophthalmologist
Lifestyle modifications: avoid smoking, control blood pressure, vitamin supplementation
Wet AMD can be treated with anti-VEGF (intraocular injection into vitreous chamber once monthly) - need to be started within 3 months for this to be beneficial.
