Age Related Macular Degeneration

Question 1

What is age related macular degeneration?

Answer 1

• This is a condition where there is degeneration in the macula that causes a progressive deterioration in vision

Question 2

What is the key finding seen during fundoscopy for ARMD?

Answer 2

• Drusen spots ( yellow pigment areas seen in the macula)

Question 3

What are the two types of ARMD?

Answer 3

• Wet and Dry

Question 4

Which type of ARMD has a worse prognosis?

Answer 4

• Wet

Question 5

What are the 4 layers of the Macula?

Answer 5

• Bottom to top:
  1. Choroid layer
  2. Bruch’s membrane
  3. Retinal pigment epithelium
  4. Photoreceptors

Question 6

What are Drusen?

Answer 6

• Drusen are yellow deposits of proteins and lipids that appear between Bruch’s Membrane and the Retinal Pigment Epithelium
• Normal Drusen are small <63micrometres and hard
• larger and greater numbers of drusen can be an early sign of macular degeneration
• common to both wet and dry AMD

Question 7

What are some signs that you would see in wet and dry AMD?

Answer 7

• Atrophy of the retinal pigment epithelium
• Degeneration of the photoreceptors
• Drusen

Question 8

What do you see on in Wet AMD?

Answer 8

• There is new vessels growing from the choroid layer into the retina
• These vessels can leak blood and cause oedema this causes a rapid loss of vision
• The chemical that stimulates the development of new vessels is VEGF

Question 9

What are the Risk factors for ARMD?

Answer 9

• Age
• Smoking
• White/ Chinese ethnic origin
• Family History
• CVD

Question 10

How does a patient with ARMD present?

Answer 10

• Gradual worsening central visual field loss
• Reduced Visual acuity
• Crooked or wavy appearance to straight lines

Question 11

What would you see on Examination for ARMD?

Answer 11

• Reduced acuity on the Snellen chart
• Scotoma ( central patch of vision loss)
• Amsler grid test ( used to assess the distortion of straight lines)
• Fundoscopy (Drusen)

Question 12

What examinations and imaging are used to make a diagnosis of ARMD?

Answer 12

• Slit-lamp biomicroscopic fundus examination
• Optical Coherence Tomography (OCT) - a technique used to gain a cross-sectional view of the layers of the retina. Can diagnose wet ARMD
• Fluorescein Angiography - involves giving a fluorescein contrast and photographing the retina to look in detail at the blood supply to the retina. it can show any oedema and neovascularisation. It is used second line to diagnose wet AMD if OCT does not exclude wet AMD

Question 13

What is the management for Dry AMD?

Answer 13

• no specific treatment
• avoid smoking
• control BP
• Vitamin supplementation has evidence in slowing progression

Question 14

What is the management of Wet AMD?

Answer 14

• Anti- VEGF medications are used to treat wet AMD
• This stops the stimulation of new blood vessels in the retina
• They are injected exactly into the Vitreous chamber of the eye, once a month
• they slow and even reduce the progression of the disease

Question 15

What are some examples of VEGF?

Answer 15

• Ranibizumab
• Bevacizumab
• Pegaptanib