age related macular degeneration (AMD)

Question 1

what is the macula

Answer 1

the central part of the retina which contains the foeva

Question 2

what are the symptoms of AMD

Answer 2

Gradual loss of central vision
May be slowly progressive - years
If associated with haemorrhage may have sudden deterioration
Distortion of vision is usually the first symptom
Eventually severe loss of central field but maintain peripheral navigational field
Difficulty reading, recognising faces
No pain or redness

(look in notes for pictures of what the loss of vision / disturbance looks like)

Question 3

what are the 2 types of AMD

Answer 3

dry (atrophic) - 90% of cases
wet (neurovascular/exudative) - less common but more severe

look in notes for images of the eyes and the difference between these in otoscopy

Question 4

outline the pathophysiology of dry AMD

Answer 4

geographic atrophy is the classic lesion found in dry AMD which causes vision loss
drusen is a small yellowish macular lesion which is often a precursor geographic atrophy. There are 2 types:
- soft drusen - pale yellow and large with ill defined margins. These are a sign of AMD in people over 55.
- hard drusen - these are round, yellow with well defined boundaries and are relatively common and not associated with AMD

(look in notes for otoscopy images)

Question 5

what treatment is available for dry AMD?

Answer 5

there is no treatment that can halt or reverse progression

• low vision aids to help reading
• vitamins
• severely sight impaired registration
• social support

Question 6

outline the pathophysiology of wet AMD

Answer 6

Choroidal neovascularization (CNV)- development of abnormal blood vessels beneath the retinal pigment epithelium layer of the retina
The new blood vessels penetrate into the retina in the macular region and bleed causing macular scarring which can result in profound loss of central vision - disciform scar
CNV can be identified on fundus fluorescein angiography
Most eyes with AMV due to CNV would be legally blind within 2 years, many within months, if left untreated

(see notes for otoscopy images)

Question 7

what treatment is available for wet AMD?

Answer 7

Treatment through injections into the eye monthly for a 2 year course - antiVEGF (VEGF induces angiogenesis). May not be effective for everybody and some people may not need an injection every month.

• Ranibizumab
• Bevacizumab
• Aflibrcept

Question 7

what treatment is available for wet AMD?

Answer 7

Treatment through injections into the eye monthly for a 2 year course - antiVEGF (VEGF induces angiogenesis). May not be effective for everybody and some people may not need an injection every month.

• Ranibizumab
• Bevacizumab
• Aflibrcept

Question 8

what are the risk factors for AMD?

Answer 8

• increasing age
• smoking
• positive family history - complement factor H gene
• sunlight
• CV risk factors - high BP, cholesterol, obesity etc