Age-related macular degeneration Flashcards
What can age-related macular degeneration (AMD) cause?
devastating los of central vision in the ageing population
What is the commonest cause of blind and partial sight in the UK In the over 60s?
age-related macular degeneration
What will happen to numbers of AMD with time?
increase as population lives longer
Do patients go completely blind in AMD?
no - peripheral vision maintained
What are 4 symptoms of AMD?
- gradual loss of central vision 2. distortion usually first symptom 3. eventually severe loss of central field but maintain peripheral navigational vision 4. difficulty with reading, recognising faces
What is speed of onset of loss of vision like in AMD?
may be very slowly progressive over years, but may have sudden deterioration if associated with haemorrhage
What kind of chart can be used to assess for central distortion from macular disease?
Amsler chart (look up image)
What are the 2 types of AMD?
- Dry (atrophic) macular degeneration 2. West (neovascular/exudative) macular degeneration
What is usually the first symptom that appears in age-related macular degeneration?
central distortion
Which is the more common form of AMD?
Dry AMD - 90%
What is the classic lesion in dry AMD?
geographic atrophy causing severe central vision loss
IS there any treatment for dry AMD?
no - nothing can halt or reverse relentless progression of dry AMD-related vision loss
What is the pre-cursor lesion leading to the development of geographic atrophy in dry AMD?
small yellowish macular lesion called drusen
What are the 2 types of drusen?
Soft and hard
What are soft drusen like? (look at photos)
pale yellow and large with ill-defined margins
What are soft drusen a sign of?
over 55 - especially larger than 63 microns - sign of age-related maculopathy
What are hard drusen like? (look at photos)
round, yellow with well-defined boundaies
How common are hard drusen?
relatively common, not always associated with AMD
Which type of drusen evolves to macular degeenration?
soft (not hard)
How does wet AMD compare in severity and frequency to dry AMD?
wet AMD is less common but more severe
What proportion of all AMD is wet AMD?
10%
What proportion of all blindness from AMD is due to wet AMD?
90%
What is wet AMD characterised by (not present in dry AMD)?
choroidal neovascularisation (CNV), development of abnormal blood vessels beneath the retinal pigment epithelium (RPE) layer of the retina
How can CNV be identified?
Fundus fluoroscein angiograph (FFA)
What happens in CNV?
new blood vessels penetrate into the retina in the macular region and bleed, which eventually causes macular scarring which can result in profound loss of central vision (disciform scar)
How many people in the UK have CNV due to AMD?
233 000; 21 000 new cases diagnosed every year
What type of scar is produced in wet AMD?
Disciform scar
How long could most eyes with AMD due to CNV under fovea be legally blind after?
2 years after diagnosis (many within months if left untreated)