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Z - old neuro and stroke > Age-Related Macular Degeneration > Flashcards

Age-Related Macular Degeneration Flashcards

1
Q

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

A

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

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2
Q

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

A

Must not have any other obvious precipitating cause

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3
Q

What kind of disease is AMD?

A

Progressive, chronic disease of the central retina

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4
Q

Why is AMD important?

A

It is a leading cause of vision loss worldwide

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5
Q

What is AMD characterised by?

A

Appearance of drusen in the macula

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6
Q

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

A

Choroidal neovascularisation

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7
Q

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

A

Geographic atrophy

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8
Q

In what respects do the forms of AMD differ?

A

In pathophysiology and progression

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9
Q

What are the characteristic lesions of dry AMD?

A
  • Soft drusen

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

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10
Q

Where does the drusen accumulate in dry AMD?

A

Between the retina and choroid

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11
Q

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

A

Atrophy and scarring of the retina

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12
Q

What happens to the atrophy in AMD over time?

A

The atrophy becomes more extensive with time

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13
Q

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

A

Yes

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14
Q

What % of cases of AMD are the dry form?

A

90%

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15
Q

Describe the progression of dry AMD

A

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

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16
Q

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

A

May or may not

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17
Q

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

A

4-12% chance/year

18
Q

What happens in wet AMD?

A

New blood vessels grow in from the choriocapillaris under the retina

19
Q

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

A

Spread under or over the RPE, or both

20
Q

Describe the abnormal blood vessels in wet AMD

A

Fragile and easily leak

21
Q

Describe the location of growth of blood vessels in wet AMD

A

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

22
Q

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

A

Can take from days to weeks

23
Q

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

A
  • Haemorrhage

- Scar formation

24
Q

What % of cases of AMD are wet AMD?

A

10%

25
Q

What % of cases of wet AMD are advanced?

A

60%

26
Q

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

A

Approx 2 years

27
Q

What is the end point of wet AMD?

A

Scar formation, known as disciform macular degeneration

28
Q

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

A

Approx 50%

29
Q

What can the severity of AMD be classified?

A
  • No AMD
  • Early AMD
  • Intermediate AMD
  • Advanced AMD
30
Q

What is classified as no AMD?

A

None or small drusen

31
Q

What is classified as early AMD?

A

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

32
Q

What is classified as intermediate AMD?

A

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

33
Q

What is classified as advanced AMD?

A

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

34
Q

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

A

All cases of wet AMD are advanced at presentation

35
Q

What causes AMD?

A

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

36
Q

What theories have been proposed regarding the cause of AMD?

A
  • Oxidative stress
  • Mitochondrial dysfunction
  • Inflammatory processes
37
Q

What are the risk factors for AMD?

A
  • 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
38
Q

What is smoking a risk factor for in AMD?

A

New-onset and progression

39
Q

What ethnicity is AMD most common in?

A

Caucasians

40
Q

What does AMD cause?

A

Painless deterioration of central vision

41
Q

How might asymptomatic AMD be identified?

A

Retinal signs may be detected incidentally during a routine eye test

42
Q

What are the general symptoms of AMD?

A
  • 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

Z - old neuro and stroke (52 decks)

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