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Year Two - Ophthalmology > Age-Related Macular Degeneration > Flashcards

Age-Related Macular Degeneration Flashcards

1
Q

What is age-related macular degeneration (ARMD)?

A

It is defined as a condition in which there is degeneration of the macula, in relation to the ageing process

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2
Q

What is the most common cause of blindless of elderly individuals?

A

Age-related macular degeneration

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3
Q

What is the macula?

A

It is the term used to refer to the central retina

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4
Q

What are the four macula layers - in order from top to bottom?

A

Photoreceptors

Retinal Pigment Epithelium

Bruch’s Membrane

Choroid Layer

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5
Q

What is the pathophysiological cause of age-related macular degeneration?

A

There is atrophy of the retinal pigment epithelium and degeneration of retinal photoreceptors

This results in the formation of drusen between the retinal pigment epithelium and Bruch’s membrane

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6
Q

What is drusen?

A

They are defined as yellow deposits of proteins and lipids

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7
Q

How do we differentiate between normal drusen and age-related macular degeneration drusen?

A

Normal drusen appear small (< 63 micrometers) and hard

Age-related macular degeneration drusen appear in greater quantities and larger (> 63 micrometers)

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8
Q

What are the two classifications of age-related macular degeneration?

A

Dry Age-Related Macular Degeneration

Wet Age-Related Macular Degeneration

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9
Q

What is the most common classification of age-related macular degeneration?

A

Dry Age-Related Macular Degeneration

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10
Q

What is dry-age related macular degeneration?

A

Dry = Drusen

It is defined as non-exudative and non-neovascular macular degeneration, in which there is the presence of asymptomatic drusen formation in the Bruch’s membrane

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11
Q

What can dry age-related macular degeneration progress into?

A

Wet age-related macular degeneration

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12
Q

What is wet age-related macular degeneration?

A

It is defined as exudative and neo-vascular macular degeneration, in which there is development of new blood vessels within the choroid layer into the retina – also known as choroidal neovascularisation

These vessels can leak fluid or blood, resulting in oedema and sudden vision loss

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13
Q

What growth hormone causes wet age-related macular degeneration?

A

Vascular endothelial growth factor (VGEF)

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14
Q

What are the two features of wet age-related macular degeneration?

A

Angiogenesis

Neovascularisation

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15
Q

What classification of age-related macular degeneration has the worst prognosis?

A

Wet age-related macular degeneration

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16
Q

What are the nine risk factors associated with age-related macular degeneration?

A

Older Age > 75 Years Old

Female Gender

White/Chinese Origin

Family History

Hypertension

Diabetes Mellitus

Dyslipidaemia

Smoking

UV Exposure

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17
Q

What are the six clinical features of age-related macular degeneration?

A

Central Visual Field Loss

Decreased Vision Acuity

Central Metamorphopsia

Photopsia

Visual Glare

Central Scotoma

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18
Q

What visual loss is associated with dry age-related macular degeneration?

A

Gradual - usually occurring over a period of several years

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19
Q

What visual loss is associated with wet age-related macular degeneration?

A

Subacute - usually occuring over a period of several days

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20
Q

What is central metamorphopsia?

A

It is defined as a crooked or wavy appearance of straight lines

21
Q

What is photopsia?

A

It is the perception of flickering or flashing lights

22
Q

What exacerbates the clinical features of age-related macular degeneration?

A

Low light conditions

23
Q

What five investigations are used to diagnose age-related macular degeneration?

A

Amsler Grid Tests

Fundoscopy

Slit-Lamp Microscopy

Ocular Coherence Tomography (OCT)

Fluorescein Angiography

24
Q

When are Amsler grid tests used to diagnose age-related macular degeneration?

A

They are the first line investigation

25
Q

What are Amsler grid tests?

A

It involves asking individuals to look at a chart, consistent of straight lines and a central back dot, whilst covering one eye at a time

26
Q

What feature indicates age-related macular degeneration on Amsler grid tests?

A

Central metamorphopsia

This is when the individual reports a loss of linearity in the grid centrally

27
Q

What three features indicate age-related macular degeneration on fundoscopy?

A

Drusen

Choroidal Neovascularisation

Geographic Atrophy

28
Q

How do drusen appear on fundoscopy?

A

They appear as yellow areas of pigment deposition in the macular area

29
Q

How does choroidal neovascularisation appear on fundoscopy?

A

It appears as well demarcated red patches

30
Q

What is the gold standard investigation used to diagnose age-related macular degeneration?

A

Slit-Lamp Microscopy

31
Q

What three features indicate age-related macular degeneration on slit-lamp microscopy?

A

Pigmentary Changes

Exudative Changes

Haemorrhagic Changes

32
Q

What is the gold standard investigation used to diagnose wet age-related macualr degeneration?

A

Ocular Coherence Tomography (OCT)

33
Q

What is ocular coherence tomography (OCT)?

A

It is a non-invasive imaging method which produces a cross sectional view of the retinal layers

34
Q

What two features indicate wet age-related macular degeneration on OCT?

A

Macular Oedema

Foveal Dip Loss

35
Q

When is fluorescein angiography used to diagnose age-related macular degeneration?

A

It is the second line investigation used to diagnose wet age-related macular degeneration

36
Q

What is fluorescein angiography?

A

It involves administration of a fluorescein contrast and imaging of the retina, in order to determine the blood supply to the retina

37
Q

What two features indicate wet-age related macular degeneration on fluorescein angiography?

A

Macular Oedema

Choroidal Neovascularisation

38
Q

When is indocyanine green angiography used to diagnsoe age-related macular degeneration?

A

This is indicated when the source of leakage is obscured by a retinal haemorrhage, and thus fluorescein may be ineffective

39
Q

What is the most appropriate next step in cases of suspected age-related macular degeneration?

A

Opthamoloy Referral

This should be an urgent two week referral in cases where wet age-related macular degeneration is suspected

40
Q

What are the four management options of dry age-related macular degeneration?

A

Low Vision Refractory Aids

AREDS2 Vitamin Formula

Smoking Cessation

Hypertension Control

41
Q

What are the seven vitamins contained in the AREDS2 formula?

A

Exogenous Antioxidants

Vitamins C & E

Beta-Carotene

Zinc

Macular Pigments

Lutein

Zeaxanthin

42
Q

What is the most effective management option to slow down the progression of dry age-related macular degeneration?

A

Smoking Cessation

43
Q

What are the two management options used to manage wet age-related macular degeneration?

A

Intravitreal Anti-VGEF Therapy

Laser Photocoagulation

44
Q

When is intravitreal anti-VGEF therapy used to manage wet age-related macular degeneration?

A

It is the first line management option

45
Q

What is the mechanism of action of intravitreal anti-VGEF therapy?

A

They inhibit vascular endothelial growth factor (VGEF) and slow the development of neovascularisation

46
Q

Name four intravitreal anti-VGEF therapies used to manage wet age-related macular degeneration

A

Aflibercept

Ranibizumab

Bevacizumab

Pegaptanib

47
Q

How are intravitreal anti-VGEF therapy administered to treat wet age-related macular degeneration?

A

It involves direct injection into the vitreous chamber of the eye once a month

48
Q

When is laser photocoagulation used to manage wet age-related macular degeneration?

A

It is the second line management option

49
Q

What is laser photocoagulation?

A

It involves the application of heat to destroy abnormal blood vessels within the retina

Year Two - Ophthalmology (12 decks)

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