Age-Related Macular Degeneration (ARMD)

Question 1

what are the layers of the macula?

Answer 1

choroid
Bruch’s membrane
RPE
photoreceptors

Question 2

which layers of the macula does drusen appear between?

Answer 2

RPE and Bruch’s membrane with atrophy of RPE and degeneration of photoreceptors

Question 3

RF for ARMD

Answer 3

age
smoking
FH
nutrition

Question 4

two types of ARMD

Answer 4

1. wet ARMD

2. dry ARMD

Question 5

what is wet ARMD?

Answer 5

new vessel growth in the choroid layer stimulated by VEGF

Question 6

what does the new vessel growth cause/risk?

Answer 6

haemorrhage

leakage causes build-up of blood and fluid which can cause scarring

Question 7

presentation of wet ARMD

Answer 7

rapid central vision loss
reduced visual acuity
metamorphopsia (bends in doorframes)
scotoma/blind-spot
pale compared to rest of fundus
haemorrhages
exudates

Question 8

diagnosis of wet ARMD

Answer 8

snellen chart
amsler grid
fundoscopy
OCT scan
fluorescein angiogram

Question 9

management of wet ARMD

Answer 9

anti-VEGF intravitreal injections

Question 10

what is dry ARMD?

Answer 10

build-up of drusen under the RPE which pushes on choroid blocking flow. retina becomes atrophic

Question 11

presentation of dry ARMD

Answer 11

gradual decline in vision
drusen and atrophic patches
orange streaks (choroidal blood vessels showing through)

Question 12

diagnosis of dry ARMD

Answer 12

ophthalmoscope

OCT

Question 13

management of dry ARMD

Answer 13

lifestyle

supportive e.g. magnifiers