Clinic: AMD workup Flashcards
What does the DRUSEN mnemonic stand for?
Diet (of fruit + green vegies = good)
Relatives (4 fold risk if sibling/parent)
Use of amsler (self monitor)
Smoking (should be stopped)
Eyetests
Nutritional supplements (consider AREDSII if intermediate AMD)
List 9 AMD risk factors
RPE disruption (i.e. via large drusen +/- pigment)
Age
Smoking
Fellow eye
Genotype (factor H for wet)
Saturated fat diet
Blue eyes
Caucasian
Female?
Classifying drusen size:
Small
Intermediate
Large
Small: <1/4BV (normal ageing)
Intermediate: <1/2 BV (early AMD)
Large: size of vein @ disc (intermediate AMD)
How to score AREDS
- Take CFP
- Score drusen + pigment within 2DD of foveaas:
Hyper/Hypo or disrupted pigment >1/4 DD = 1
Large drusen > 125 microns = 1
Modifiers:
Reticular drusen = + 1
Bilateral intermediate drusen = + 1
End stage AMD in fellow eye = + 1
Max score = 4 for any person
What is the risk of progression in 5 years for the following AREDS scores?
0-1
2
3
4
0-1: 3%
2: 12% (med risk)
3: 25% (high risk)
4: 50% (v high risk)
How often should you review the following AREDS scores:
0-1
2
3
4
0-1: 2 years
2: 1 year
3: 6 months
4: 3 months
How should you workup an AMD patient? (3)
Measure visual function (VA @ HC + LC; VF - macula)
DFE - look for mac swelling, CNVM
OCT - mac cube or single line through fovea (mac horizontal?)
On what OCT results should you refer a AMD patient to a retinal specialist?
Foveal thickness > 300 microns and/or
Central retinal thickness > 350 microns
List the 5 OCT signs of CNVM
IsE disruption (indicates advanced disease)
Sub retinal fluid (dark bands)
Cystic formation within inner retinal layers (dark bubbles)
PED (clear internal cf drusen which is milky)
Increase in foveal thickness >100 microns b/w eyes or >350 microns