Age-related macular degeneration

Question 1

What is AMD?

Answer 1

Progressive condition affecting the macula. Most common cause of blindness in UK.
Two types:
Wet - 10% cases.
Dry - 90% cases

Question 2

Features of dry/wet AMD?

Answer 2

Dry - drusen deposits around bruch’s membrane.
Wet - Choroidal neovascularisation. Worst prognosis

Question 3

Clinical features of age related macular degeneration?

Answer 3

Reduction in visual acuity - gradual in dry and subacute in wet.
Deterioration in night vision.
Fluctuations in visual disturbence (may vary day to day)
Photopsia (flickering/flashing lights)
Visual hallucinations.
Distortion of line perception on Amsler grid testing*

Question 4

Investigations for AMD?

Answer 4

Slit land microscopy (initial ix of choice).
Fluorescein angiography - if neovascular ARMD is suspected.
Optical coherence tomography to visulise retina in 3D

Question 5

Treatment of Age related macular degeneration

Answer 5

Dry - Vitamin supplements to slow progression, avoid smoking and control BP.
Wet - Anti-VEGF medications which are injected into vitreous chamber. Eg, Ranibizumab.

Question 6

Risk factors for ARMD?

Answer 6

Older age,
Smoking,
Family history,
CV disease,
Obesity,
Poor diet which is low in vitamins and high in fat.

Question 7

Acute causes of visual loss?

Answer 7

Vascular - AION, retinal venous and arterial occlusion.
Retinal detachment,
Vitrous haemorrhage,
Wet ARMD
Acute glaucoma (painful)

Question 8

Chronic causes of visual loss?

Answer 8

Cataracts,
Dry ARMD,
Glaucoma