Age related macular degeneration Flashcards
What are the two types of ARMD?
Wet
Dry
What is ARMD?
A progressive loss of central vision associated with drusen formation and changes in the retinal pigment epithelium
What causes ARMD?
increasing age Ethnicity FH Smoking HTN Diet high in fat Aspirin Sunlight exposure Female Blue eyes Previous cataract surgery
What is the most common type of ARMD?
Dry - 90%
Describe dry ARMD
non-exudative and non-neovascular
Asymptomatic drusen on bruchs membrane
What are drusen
small yellow deposits which are visible on fundoscopy
What pathological changes happen when ARMD progresses?
pigmentary changes in the retinal pigmentary epithelium
Geographic atrophy
What is the time progression in dry ARMD?
Slow
Describe wet ARMD
Characterised by the formation of choroidal neovascularisation made up of new aberrant blood vessels underneath the retina - this is driven by vascular endothelial growth factor (VEGF). This results in leaky vessels and haemorrhage
What are some typical symptoms of ARMD
Progressive central vision loss
If acute - more likely to be wet ARMD
Symptoms vary throughout the day and are exacerbated by low light
Associated symptoms such as halos around lights and floaters
Describe the clinical examination of ARMD
Visual field assessment
Amsler grid
Fundoscopy
What investigations should be done for ARMD
OCT
Fluorescein angiography
Indocyanine green angiography
Autoflourescent imaging
Describe the management of dry ARMD
Low refractory aids may be useful
Vitamin supplements - AREDS2 formula - exogenous antioxidants, vitamin C and E, beta carotene, zinc, macular pigments, lutein, zeaxanthin
Describe the management of wet ARMD
Significant and rapidly progressive disease - aggressive management - intravitreal antiVEGF therapy for 3 months
Name some anti-VEGF therapies
Aflibercept, ranibizumab, bevacizumab and pegaptanib
