Age-Related Macular Degeneration

Question 1

What does the term age-related macular degeneration (AMD) refer to?

Answer 1

Ageing changes that occur in the central area of the retina in people aged 55 years or older

Question 2

What needs to be true of the changes in the central area of the retina to be classified as AMD?

Answer 2

Must not have any other obvious precipitating cause

Question 3

What kind of disease is AMD?

Answer 3

Progressive, chronic disease of the central retina

Question 4

Why is AMD important?

Answer 4

It is a leading cause of vision loss worldwide

Question 5

What is AMD characterised by?

Answer 5

Appearance of drusen in the macula

Question 6

What is the appearance of drusen in the macula accompanied by in wet AMD?

Answer 6

Choroidal neovascularisation

Question 7

What is the appearance of drusen in the macula accompanied by in wet AMD?

Answer 7

Geographic atrophy

Question 8

In what respects do the forms of AMD differ?

Answer 8

In pathophysiology and progression

Question 9

What are the characteristic lesions of dry AMD?

Answer 9

• Soft drusen

- Changes in pigmentation (hypopigmentation and/or hyperpigmentation) of the retinal pigment epithelium

Question 10

Where does the drusen accumulate in dry AMD?

Answer 10

Between the retina and choroid

Question 11

What does the accumulation of drusen between the retina and choroid in dry AMD cause?

Answer 11

Atrophy and scarring of the retina

Question 12

What happens to the atrophy in AMD over time?

Answer 12

The atrophy becomes more extensive with time

Question 13

Can dry AMD progress and cause vision loss without turning into the wet form?

Answer 13

Yes

Question 14

What % of cases of AMD are the dry form?

Answer 14

90%

Question 15

Describe the progression of dry AMD

Answer 15

Progression to visual loss is usually gradual, but eventually there is an area of partial or complete atrophy of the retinal pigment epithelium

Question 16

Does the atrophy of the RPE in dry AMD involve the fovea?

Answer 16

May or may not

Question 17

What chance to those with dry AMD have of developing wet AMD?

Answer 17

4-12% chance/year

Question 18

What happens in wet AMD?

Answer 18

New blood vessels grow in from the choriocapillaris under the retina

Question 19

In relation to the RPE, where to the blood vessels grow in wet AMD?

Answer 19

Spread under or over the RPE, or both

Question 20

Describe the abnormal blood vessels in wet AMD

Answer 20

Fragile and easily leak

Question 21

Describe the location of growth of blood vessels in wet AMD

Answer 21

They start off to the side of the retina and grow towards the centre, eventually growing under the macula

Question 22

How long does the process of blood vessel growth take in wet AMD?

Answer 22

Can take from days to weeks

Question 23

What are the consequences of abnormal vessel formation in wet AMD?

Answer 23

• Haemorrhage

- Scar formation

Question 24

What % of cases of AMD are wet AMD?

Answer 24

10%

Question 25

What % of cases of wet AMD are advanced?

Answer 25

60%

Question 26

How quickly will wet AMD progress to cause severe visual impairment without treatment?

Answer 26

Approx 2 years

Question 27

What is the end point of wet AMD?

Answer 27

Scar formation, known as disciform macular degeneration

Question 28

What % of patients who have had wet AMD in one eye will develop it in their second eye within 5 years?

Answer 28

Approx 50%

Question 29

What can the severity of AMD be classified?

Answer 29

- No AMD - Early AMD - Intermediate AMD - Advanced AMD

Question 30

What is classified as no AMD?

Answer 30

None or small drusen

Question 31

What is classified as early AMD?

Answer 31

Multiple small or a few intermediate drusen, with or without abnormalities of the retinal pigmented membrane

Question 32

What is classified as intermediate AMD?

Answer 32

Extensive intermediate or 1+ large drusen, with or without GA not involving the fovea

Question 33

What is classified as advanced AMD?

Answer 33

GA involving the fovea, with or without any features of wet AMD

Question 34

What is the result of features of wet AMD be classified as advanced?

Answer 34

All cases of wet AMD are advanced at presentation

Question 35

What causes AMD?

Answer 35

AMD is a multifactorial disease, with both environmental and genetic components playing a role in its development, however the specific causes are not known

Question 36

What theories have been proposed regarding the cause of AMD?

Answer 36

- Oxidative stress - Mitochondrial dysfunction - Inflammatory processes

Question 37

What are the risk factors for AMD?

Answer 37

- Increasing age - Smoking - Family history - Cardiovascular risk factors (for wet AMD) - Light coloured eyes - Diets high in fat, cholesterol, and high glycaemic index foods - Obesity - Ethnicity

Question 38

What is smoking a risk factor for in AMD?

Answer 38

New-onset and progression

Question 39

What ethnicity is AMD most common in?

Answer 39

Caucasians

Question 40

What does AMD cause?

Answer 40

Painless deterioration of central vision

Question 41

How might asymptomatic AMD be identified?

Answer 41

Retinal signs may be detected incidentally during a routine eye test

Question 42

What are the general symptoms of AMD?

Answer 42

- Reduction in visual acuity - Loss of or decreased contrast sensitivity - Size or colour of objects appearing different with each eye - Abnormal dark adaptation - Photopsia - Light glare - Visual hallucinations