AMD

Question 1

AMD Risk Factors

Answer 1

• Diet low in omega 3 & 6, and cartenoids and minerals
• Lack of exercise
• Smoking
• Older age
• Hypertension
• Family history of AMD
• High BMI
• High fat diet
• Presence of AMD in fellow eye

Question 2

How to Gauge Size of Drusen?

Answer 2

• Vein as it leaves disc is 125 micrometers
• Compare drusen to this size

Question 3

Normal Eyes According to NICE Classification

Answer 3

• No signs of AMD
• Small drusen (<63um)

Question 4

Early Dry AMD According to NICE Classification

Answer 4

Low risk of progression
- Medium drusen (63um < x <125um)
- Pigmentary abnormalities
Medium risk of progression
- Large drusen (>125um)
- Reticular drusen
- Medium drusen with pigmentary abnomalities
High risk of progression
- Large drusen (>125um) with pigmentary abnormalities
- Reticular drusen with pigmentary abnormalities
- Vitelliform lesion with VA 6/18 or better
- Atrophy <175 um and not involving fovea

Question 5

Late Dry AMD According to NICE Classification

Answer 5

• Geographic atrophy (in absence of neovascular AMD)
• Significant visual loss (worse than 6/18)
  
  • Dense/confluent drusen
  • Advanced pigmented changes
  • Vitelliform lesion

Question 6

What is Reticular Drusen?

Answer 6

• Drusen-like lesions which lie above the RPE unlike normal drusen
• Sign of AMD progression

Question 7

What is a Vitelliform Lesion?

Answer 7

• Accumulation of lipofuscin
• In subretinal space
• Highly reflective lesion

Question 8

When to Refer Dry AMD

Answer 8

• Normally no referral
• For certification for visual impairment
• For use of low vision services
• New symptoms which suggest wet AMD
• To participate in research

Question 9

Late Wet AMD According to NICE Classification

Answer 9

Late Wet Active AMD
- Classic choroidal neovasulcarisation
- Occult neovascularisation
- Mixed
- Retinal angiomatous proliferation (RAP)
- Polypoidal choroidal vasculopathy

Late Wet Inactive AMD
- Fibrous scar
- Sub-foveal atrophy or fibrosis
- Atrophy
- Cystic degeneration

Question 10

What is Occult Choroidal Neovascularisation?

Answer 10

• Leakage is underneath RPE

Question 11

Wet AMD Management

Answer 11

• Urgent referral to macular clinic (not same day)
• Anti-VEGF injections
  
  • Course of 3 injections at monthly intervals
  • Review and monitor
  • If working then continue
• Optometrists can be used to monitor AMD

Question 12

When are AMD Patients Discharged?

Answer 12

• Discharge is based on
  
  • How stable condition is
  • if treatment will have any further benefits
• Discharged patients should report to optometrists if new symptoms develop
• Keep a particular eye on patients with monocular AMD