Age-related Macular Degeneration

Question 1

Age-related macular degeneration is the most common cause of blindness in the UK. TRUE/FALSE?

Answer 1

TRUE

Question 2

Risk factors for ARMD

Answer 2

advancing age >75
females
Smoking
FHx
patients with increased cardiovascular risk

Question 3

Which type of macular degeneration it described?

• 90% of cases
• AKA atrophic MD
• characterised by drusen - yellow round spots in Bruch’s membrane

Answer 3

Dry macular degeneration

Question 4

Which type of macular degeneration is described?

• 10% of cases
• AKA exudative or neovascular MD
• characterised by choroidal neovascularisation
• leakage of serous fluid and blood can result in a rapid loss of vision
• worst prognosis

Answer 4

wet macular degeneration

Question 5

How do patients typically present?

Answer 5

• reduction in visual acuity, particularly for near field objects
• deterioration in vision at night
• fluctuations in visual disturbance
• photopsia, (a perception of flickering or flashing lights)
• glare around objects
  -distortion of line perception

Question 6

Fundoscopy signs of macular degeneration

Answer 6

• drusen (yellow spots)

wet ARMD
- intra-retinal or sub-retinal fluid leakage or haemorrhage.

Question 7

Investigations for ARMD

Answer 7

slit-lamp microscopy
- identifies exudative or haemorrhagic changes affecting the retina

colour fundus photography

fluorescein angiography
- can guide intervention with anti-VEGF therapy.

optical coherence tomography- to visualise the retina in 3D

Question 8

Management of ARMD

Answer 8

• zinc with anti-oxidant vitamins A,C and E reduced progression of the disease by 1/3
• vascular endothelial growth factor (VEGF)
• use within the first two months of diagnosis of wet ARMD if possible

laser photocoagulation
(risk of acute visual loss)

Question 9

Examples of anti-VEGF agents

Answer 9

ranibizumab
bevacizumab
pegaptanib

Question 10

How often are anti-VEGF agents usually administered?

Answer 10

administered by 4 weekly injection.