AMD Flashcards
What are the modifiable risk factors for AMD?
Smoking
Weight
Lack of exercise
Hypertension
(Sunlight exposure)
(Heavy alcohol consumption)
What are the unmodifiable risk factors for AMD?
Age
Family history
(Caucasian race)
(Female gender)
What clinical features are present in early AMD?
Drusen
Pigmentary changes
What clinical features are present in late AMD?
Geographic Atrophy
Choroidal Neovascularisation
What clinical features are present in dry AMD?
Drusen
Pigmentary changes
Geographic Atrophy
What clinical features are present in wet AMD?
Choroidal Neovascularisation
What are drusen and where do they form?
Lipid/protein extracellular deposits between Bruch’s membrane and the RPE
What size are drusen compared to to determine if they’re hard or soft?
63um (width of a blood vessel)
If under: hard AKA drupelets
If over: soft
What is geographic atrophy?
Loss of PRs, revealing area of depigmentation so choroid is visible, well-circumscribed
What is choroidal neovascularisation?
Neovasc originating from the choroid which breach Bruch’s membrane and invade sub-RPE/retina
What can CNV lead to?
Fibrovascular Proliferation (leads to vitreous haem and tractional retinal detachment)
What is Fibrovascular Proliferation?
Growth of fibrous elements from new blood vessels which could contract, leading to vitreous haem and RD
What causes VEGF release?
Abnormal retinal changes seen in AMD
What happens as a result of VEGF release?
Neovascularisation, inflammation and increased vessel permeability
How can AMD be imaged?
OCT
Fundus photography
Fluorescein angiography
Indocyanine green angiography
How is Fluorescein angiography helpful to assess AMD?
Can visualise CNV more easily as can view blood flow into choroid
How is Indocyanine green angiography helpful in assessing AMD?
Visualises poorly circumscribed areas more easily due to longer wavelength of green dye (compared to NaFl)
What are some previous treatments for AMD?
Surgical movement of macular
Photodynamic therapy
How does anti-VEGF work?
The drug injected binds to receptor sites on VEGF, stopping it from binding - so stopping neovasc, inflammation and increased vessel permeability
What is the brand name of Ranibizumab?
What is it licensed for?
What is injected?
How often is it injected?
Core
Lucentis
Wet AMD
Antibody fragment
Monthly injection
What is the brand name of Bevacizumab?
What is it licensed for?
What is injected?
How often is it injected?
Further
Avastin
Oncology but used in AMD
Full length antibody
Monthly injection
What is the brand name of Aflibercept?
What is injected?
How often is it injected?
Core
Eylea
‘VEGF trap’ fusion protein - decoy receptor
Injected every 8 weeks
What is the brand name of Brolucizumab?
What is injected?
Further
Beovu
Single chain antibody fragment - small so penetrates and leaves circulation quickly
What is the brand name of Faricimab?
What is injected?
How often is it injected?
Further
Vabysmo
Bispecific antibody - inhibits angoprotein-2 and VEGF
Injected every 16 weeks
What is the brand name of Pegaptanib?
What is injected?
When did NICE stop recommending its use?
Macugen
RNA fragment
2015
What are the NICE guidelines for treatment of AMD?
VA - between 6/12 and 6/96
No permanent structural damage to central fovea
lesions are less than or equal of 12 disc areas
Evidence of recent disease progression (neovasc, VA changes, Amsler distortion)
What are possible future treatments?
Gene therapy
Anti-inflammatory therapy (corticosteroids)
Combination of anti-VEGF and corticosteroids
Stem cell therapies
What nutritional guidance should you give to patients with AMD?
Eat lots of dark green leafy veg and orange/yellow foods
Fish 3-4 times per week
Supplements of vitamins/minerals (not specific brands!)
What nutrients help to defend against oxidative damage in the retina?
Vitamins C and E
Beta-carotene
Zinc
Omega-3 fatty acids
Carotenoids (Lutein and Zeaxanthin)
