Age Related Macular Degeneration: Gradual Vision Loss Flashcards

1
Q

What is age-related macular degeneration (ARMD)?

A

Most common cause of blindness in the UK.

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2
Q

What is the pathophysiology of ARMD?

A

Degeneration of the central retina (macula)
Degeneration of retinal photoreceptors resulting in the formation of drusen which can be seen on fundoscopy and retinal photography
Changes usually bilateral

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3
Q

What are the two forms of ARMD?

A

Dry and Wet

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4
Q

What is dry ARMD?

A

90% of cases, geographic atrophy

Macular degeneration characterised by drusen.

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5
Q

What are drusen?

A

Yellow, round spots in Bruch’s membrane

seen in dry ARMD

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6
Q

What is wet ARMD?

A

10% of cases, exudative, neovascular
Macular degeneration, characterised by choroidal neovascularisation
Leakage of serous fluid and blood can subsequently result in a rapid loss of vision. Carries the worst prognosis

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7
Q

What is early ARMD?

A

(Similar to dry)

Non-exudative, age-related maculopathy: drusen and alterations to the retinal pigment epithelium (RPE)

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8
Q

What is late ARMD?

A

(Similar to wet)
Neovascularisation
Exudative

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9
Q

What is the epidemiology of ARMD?

A

Most common cause of visual loss in elderly persons in the developed world
Male: Female 1:2
Avg. >70 yo

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10
Q

What are the risk factors of ARMD?

A

Advancing age
Smoking (2x likely)
Family history
CVD Rfx: Hypertension, dyslipidaemia, diabetes mellitus.

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11
Q

What is the presentation of ARMD?

A

Sub-acute onset visual loss

Reduction in visual acuity (

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12
Q

What are the signs of ARMD?

A

Distorsion of line perception on Amsler grid testing
Fundoscopy: drusen (yellow pigment in macular area)
(Wet ARMD: well demarcated red patches which may represent intra-retinal or sub-retinal fluid leakage or haemorrhage)

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13
Q

What are the investigations of ARMD?

A

SLIT-LAMP MICROSCOPY (to identify pigmented, exudative or haemorrhagic changes)
COLOUR FUNDUS PHOTOGRAPHY (baseline for changes over time)

Wet: FLUOROSCEIN ANIOGRAPHY is neovascular ARMD is suspected with indocyanine green angiography.

OCULAR COHERENCE TOMOGRAPHY to visualise the retina in three dimensions

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14
Q

What is the treatment of dry ARMD?

A

(AREDS trial)
Zinc and anti-oxidant vitamins A, C and E reduce progression of the disease

(Laser photocoagulation - can be used in both)

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15
Q

What is the treatment of wet ARMD?

A

Anti - Vascular endothelial growth factor (VEGF)
Anti-VEGF can limit the progression.

Ranibizumab, Bevacizumab, Pegaptanib.

(Laser photocoagulation - can be used in both)

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