Age-Related Macular Degeneration

Question 1

what is the most common cause of blindness in the UK?

Answer 1

age-related macular degeneration

Question 2

what is age-related macular degeneration?

Answer 2

degeneration of the central retina (macula)

Question 3

what is the key feature in age-related macular degeneration?

Answer 3

bilateral

Question 4

what is the pathophysiology of age-related macular degeneration?

Answer 4

1. degeneration of retinal photoreceptors
2. formation of drusen

Question 5

what are the risk factors for age-related macular degeneration?

Answer 5

• advancing age
• smoking
• FHx
• female
• increased risk of ischaemic cardiovascular disease

Question 6

what are the 2 types of age-related macular degeneration?

Answer 6

• wet
• dry

Question 7

what is the most common type of age-related macular degeneration?

Answer 7

dry (90%)

Question 8

what is the characteristic of dry age-related macular degeneration?

Answer 8

drusen

yellow round spots in Bruch’s membrane

Question 9

what type of age-related macular degeneration is associated with the worst prognosis?

Answer 9

wet

Question 10

what is wet age-related macular degeneration characterised by?

Answer 10

choroidal neovascularisation

Question 11

describe the vision loss experienced in age-related macular degeneration?

Answer 11

• reduction in visual acuity (particular for near field objects)
• difficulties in dark adaptation
• fluctuations in visual disturbance
• photopsia (flickering/flashing lights)

Question 12

what is the different in vision loss between wet and dry age-related macular degeneration?

Answer 12

dry = GRADUAL
wet = SUBACUTE

Question 13

what is charles-bonnet syndrome?

Answer 13

visual hallucinations caused by the brain’s adjustment to significant vision loss

Question 14

what conditions is age-related macular degeneration associated with?

Answer 14

charles bonnet syndrome

Question 15

what are the signs of age-related macular degeneration?

Answer 15

• distortion of line perception noted on Amsler grid testing
• fundoscopy = drusen

Question 16

describe fundoscopy findings in age-related macular degeneration?

Answer 16

drusen
* yellow areas of pigment deposition in the macular area
* confluent in late disease -> macular scar

Question 17

what is seen on fundoscopy in wet age-related macular degeneration?

Answer 17

demarcated red patches
* intra-retinal or sub-retinal fluid leakage or haemorrhage

Question 18

what is the initial investigation of choice in age-related macular degeneration?

Answer 18

slit-lamp microscopy

Question 19

what investigation is done if wet age-related macular degeneration is suspected?

Answer 19

fluorescein angiography

can guide intervention with anti-VEGF therapy

Question 20

what is the management of dry age-related macular degeneration?

Answer 20

zinc + vit A, C and E

Question 21

what is the managemnet of wet age-related macular degeneration?

Answer 21

4 weekly anti-VEGF injections

Question 22

what is vascular endothelial growth factor?

Answer 22

potent mitogen and drives increased vascular permeability

Question 23

name some anti-VEGF agents

Answer 23

• ranibizumab
• bevacizumab
• pegaptanib

Question 24

what is an alternative treatment to anti-VEGF in wet age-related macular degeneration?

Answer 24

laser photocoagulation