Age Related Macular Degeneration

Question 1

Age related macular degeneration is the most common cause of [BLANK] in the UK?

Answer 1

Blindness

Question 2

What is the key feature of age related macular degeneration?

Answer 2

Degeneration of the central retina (Macula)

Question 3

Is it unilateral or bilateral?

Answer 3

Bilateral

Question 4

What 2 forms of macular degeneration are seen?

Answer 4

• Dry
• Wet

Question 5

Describe the difference between dry and wet age related macular degeneration.

Answer 5

• Dry macular degeneration - characterised by:
  
  • Drussen which form in the layer called the RPE (retinal pigment epithelium).
  • Many people have drussen but in dry macular degeneration there are many and they are large.
  • RPE then atrophies and there is a loss of vision from loss of photoreceptors in the macula.
• Wet macular degeneration - characterised by:
  
  • Choroidal neovascularisation - these are new blood vessels in the retina are fragile and leak serous fluid and blood below the macula.
  • This can result in a rapid loss of vision.

Question 6

Which has a worse prognosis?

Answer 6

Wet age related macular degeneration

Question 7

Describe the updated classification for age related macular degeneration.

Answer 7

• Early age related macular degeneration (non-exudative, age related maculopathy): drusen and alterations to the retinal pigment epithelium (RPE)
• Late age related macular degeneration (neovascularisation, exudative)

Question 8

What are some risk factors for age related macular degeneration?

Answer 8

• Age: most patients are over 60 years of age
• Smoking
• Family history
• More common in Caucasians
• High cumulative sunlight exposure
• Female sex

Question 9

What are some clinical features of agre related macular degeneration?

Answer 9

• Reduced visual acuity: ‘blurred’, ‘distorted’ vision
• Central scotomas
• Fundoscopy: drusen, pigmentary changes

Question 10

Which part of the vision is affected first?

Answer 10

Central vision is affected first

Question 11

What advise can be given to help slow down visual loss in patients with established macular degeneration?

Answer 11

1. Stop smoking
2. High dose of beta-carotene
3. Vitamins C & E
4. Zinc

Question 12

Why should supplements (vitamin C, E and zinc) be avoided in smokers?

Answer 12

They lead to an increased risk of lung cancer

Question 13

What is the treatment for dry macular degeneration?

Answer 13

There is currently no medical treatment

Question 14

What is the treatment for wet macular degeneration?

Answer 14

• Photocoagulation
• Photodynamic therapy
• Anti-vascular endothelial growth factor (anti-VEGF) treatments: intravitreal ranibizumab

Question 15

What tool can be used to help recognize AMD?

Answer 15

Amsler Grid