Age Related Macular Degeneration Flashcards

1
Q

classify age related macular degeneration (ARMD)

A
  1. wet - neovascular
  2. dry - non-neovascular
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2
Q

what is ARMD?

A

age-related deterioration in the macula leading to the reduction in central vision

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3
Q

what is the macula?

A

the central area of the retina

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4
Q

what are the risk factors of ARMD?

A
  1. age
  2. smoking
  3. females
  4. ethnic origin - white
  5. dietary factors
  6. CV risk
  7. long-sighted
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5
Q

describe dry ARMD

A

gradual but reduces central vision

affects 90% of ARMD

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6
Q

what are the clinical features of dry ARMD

A
  1. Drusen
    • PAS-positive amorphous deposite between RPE basement membrane and inner collagenous layer of Bruch’s membrane
  2. RPE changes
    • Focal hyperpigmentation (clumps of pigment cells)
  3. Geographic atrophy (advanced / later stages)
    • Loss of RPE
    • Loss of photoreceptors
  4. Basement membrane deposit (basal linear deposit)
    • Between RPE basement membrane and RPE cells
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7
Q

what are the symptoms of dry ARMD?

A
  1. decreased central vision
  2. distortion
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8
Q

what is the treatment of dry ARMD?

A
  1. Support - counselling/visual aid
  2. refract
  3. amsler grid
  4. lifestyle changes - diet/smoking
  5. vitamin supplements
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9
Q

what vitamin supplements are given in dry ARMD?

A
  • 500 milligrams (mg) of vitamin C
  • 400 international units (equivalent to about 270mg) of vitamin E
  • 10 mg lutein
  • 2 mg zeaxanthin
  • 25 mg or 80 mg zinc as zinc oxide (as recommended by your
    doctor)
  • 2 mg copper as cupric oxide
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10
Q

describe wet ARMD

A

rapid, severe loss of vision

less common

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11
Q

what is the pathology of wet ARMD

A
  1. new capillaries through the bruchs membrane
  2. proliferation beneath RPE/retina
  3. other e.g. haemorrhage/leakage/scarring
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12
Q

what are the clinical features of wet ARMD

A
  1. decreased vision
  2. distortion and missing patches
  3. grey membrane on examination
  4. haemorrhage
  5. fluid
  6. subretinal fibrosis
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13
Q

what does OCT detect?

A

investigating/monitoring …
subretinal fluid
intraretinal fluid
pigment epithelial detachment
fibrosis/scarring

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14
Q

what does fundus fluorescin angiogram detect?

A

fluorscent dye injected intravenously - absorbing blue light and emitting yellow/green lights

image of circulating in the eye

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15
Q

what is the treatment of wet ARMD?

A
  1. support - counselling/visual aids
  2. intravitreal anti-VEGF therapy
  3. photodynamic therapy
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16
Q

name licensed anti-VEGF

A
  1. ranibizumab
  2. aflibercept
17
Q

what are the risks of anti-VEGF?

A
  • Infection (endophthalmitis)
  • Retinal detachment
  • Lens damage / cataract
  • Raised intraocular pressure
  • Haemorrhage (conjunctival, vitreous)
  • Inflammation
  • Pain
  • Visual loss
  • Floaters (expected – drug in vitreous)