Age-related macular degeneration Flashcards
most common cause of blindness in the UK
Age-related macular degeneration
risk factors for ARMD?
AGE!
smoking
family history is also a strong risk factor
ssociated with an increased risk of ischaemic cardiovascular disease, such as hypertension, dyslipidaemia and diabetes mellitus.
classification of age related macula degeneration ?
dry macular degeneration - 90 recent of cases
wet macular degeneration
clinical features of macular degeneration
a reduction in visual acuity, particularly for near field objects
gradual in dry ARMD
subacute in wet ARMD
difficulties in dark adaptation
deterioration in vision at night
fluctuations in visual disturbance which may vary significantly from day to day
photopsia, (a perception of flickering or flashing lights), and glare around objects
what syndrome is linked with Age related macula degeneration ?
Charles-Bonnet syndrome - visual hallucinations
general diagnosis of ARMD?
Amsler grid testing- distortion of line perception
fundoscopy
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slit-lamp microscopy is the initial investigation of choice + colour fundus photography
slit lamp microscopy to identify any pigmentary, exudative or haemorrhagic changes affecting the retina which may identify the presence of ARMD.
accompanied by colour fundus photography to provide a baseline against which changes can be identified over time.
what can be even in fundoscopy of dry macula degeneration ?
drusen - yellow round spots in Bruch’s membrane
and alterations to the retinal pigment epithelium (RPE)
wet macular degeneration is also known as ?
exudative or neovascular macular degeneration
what can be even in fundoscopy of wet/exudative or neovascular macula degeneration ?
well demarcated red patches may be seen which represent intra-retinal or sub-retinal fluid leakage or haemorrhage
pthophysio of wet/exudative or neovascular macula degeneration ?
choroidal neovascularisation
leakage of serous fluid and blood can subsequently result in a rapid loss of vision
carries the worst prognosis
if neovascular ARMD is suspected what is the diagnostic of choice ?
fluorescein angiography - guide intervention with anti-VEGF therapy
indocyanine green angiography to visualise any changes in the choroidal circulation.
ocular coherence tomography is used to ?
visualise the retina in three dimensions because it can reveal areas of disease which aren’t visible using microscopy alone.
treatment of dry / age related ARMD
moderate category dry ARMD:
combination of zinc with anti-oxidant vitamins A,C and E - reduced progression of the disease by around one third.
treatment of wet ARMD
anti-VEGF agents can limit progression of wet ARMD and stabilise or reverse visual loss
= should be instituted within the first two months of diagnosis
examples of anti-VEGF
ranibizumab, bevacizumab and pegaptanib
