Age Related Macular Degeneration

Question 1

classify age related macular degeneration (ARMD)

Answer 1

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

Question 2

what is ARMD?

Answer 2

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

Question 3

what is the macula?

Answer 3

the central area of the retina

Question 4

what are the risk factors of ARMD?

Answer 4

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

Question 5

describe dry ARMD

Answer 5

gradual but reduces central vision

affects 90% of ARMD

Question 6

what are the clinical features of dry ARMD

Answer 6

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

Question 7

what are the symptoms of dry ARMD?

Answer 7

1. decreased central vision
2. distortion

Question 8

what is the treatment of dry ARMD?

Answer 8

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

Question 9

what vitamin supplements are given in dry ARMD?

Answer 9

• 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

Question 10

describe wet ARMD

Answer 10

rapid, severe loss of vision

less common

Question 11

what is the pathology of wet ARMD

Answer 11

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

Question 12

what are the clinical features of wet ARMD

Answer 12

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

Question 13

what does OCT detect?

Answer 13

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

Question 14

what does fundus fluorescin angiogram detect?

Answer 14

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

image of circulating in the eye

Question 15

what is the treatment of wet ARMD?

Answer 15

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

Question 16

name licensed anti-VEGF

Answer 16

1. ranibizumab
2. aflibercept

Question 17

what are the risks of anti-VEGF?

Answer 17

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