Age-related macular degeneration Flashcards
What is it?
What age group is it seen in?
Macular changes without an obvious cause
Elderly
2 types of advanced AMD?
Early or intermediate AMG has no visual symptoms.
Wet
Dry (more common - happens over decades)
Dry AMD:
- What lipid causes is deposited? - D
- What does this lipid cause?
Drusen - are small yellow deposits of fatty proteins (lipids) that accumulate under the retina.
Causes atrophy of retinal pigmented epithelium - RPE
Wet AMD:
- What grows from the choroid into the retina?
- What does this lead to?
New blood vessels and they leak
Scarring and detachment
What does age-related maculopathy refer to?
The pre-clinical stage of the disease
Vision:
What happens to straight lines?
What is micro/macropsia?
What parts of the vision is primarily affected?
In Wet AMD, what other things could they see in their vision?
What may the patient find difficulty with?
Bi/unilateral?
Which type of AMD has rapid disease progression and needs immediate Rx?
Straight lines look wavy
Objects look smaller than normal
Central vision - black/grey scotoma
Floaters
Flashes (photopsia)
Difficulty driving, reading, recognising faces, night vision
Usually bilateral, but may be asymmetrical
Wet AMD
Fundoscopy:
What may you see for wet AMD?
- Grayish-green retinal discolouration
- Serous detachment of the retina and the retinal pigment epithelium
- Subretinal and intraretinal haemorrhage and/or exudate
- Fibrous disciform scars
LOOK AT PICS
Fundoscopy:
What may you see for dry AMD?
Drusen
Retinal pigment epithelium atrophy
Retinal pigment epithelium hypertrophy (mottling)
LOOK AT PICS
Risk factors:
Age FH Smoking HTN Obesity
Investigations:
What type of exam is used to diagnose?
What is an optical coherence tomography (OCT)?
Why is it used?
Slit-lamp exam - can see a clearer view of fundoscopy findings
A non-invasive imaging test. OCT uses light waves to take cross-section pictures of your retina. With OCT, your ophthalmologist can see each of the retina’s distinctive layers. This allows your ophthalmologist to map and measure their thickness
Rules out Wet AMD (does not confirm)
Investigations:
What type of imaging can be used to confirm Wet AMD if you think about the haemorrhaging?
Fluorescein angiography
Management:
Lifestyle advice - 1
What vitamins can be advised/prescribed?
What do you also need to make sure isn’t present to give them the best vision possible?
What should you encourage the patient to do to access benefits?
Who should be contacted for the patient and others safety?
Smoking cessation
Vit C and E
Beta-carotene
Zinc
Refractive errors corrected by an optician
Get a certificate of Vision Impairment by an ophthalmologist.
DVLA - cannot drive if they can’t read a number plate from 20 metres away
Management:
There is no specific treatment for dry AMD!!!!
Wet ARMD:
What is prescribed that increases acuity and decreases cell proliferation, neovascularization and vascular leaks?
Intravitreal VEGF - vascular endothelial growth factor
