Clinic: AMD workup

Question 1

What does the DRUSEN mnemonic stand for?

Answer 1

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)

Question 2

List 9 AMD risk factors

Answer 2

RPE disruption (i.e. via large drusen +/- pigment)
Age
Smoking
Fellow eye
Genotype (factor H for wet)
Saturated fat diet
Blue eyes
Caucasian
Female?

Question 3

Classifying drusen size:
Small
Intermediate
Large

Answer 3

Small: <1/4BV (normal ageing)
Intermediate: <1/2 BV (early AMD)
Large: size of vein @ disc (intermediate AMD)

Question 4

How to score AREDS

Answer 4

1. Take CFP
2. 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

Question 5

What is the risk of progression in 5 years for the following AREDS scores?
0-1
2
3
4

Answer 5

0-1: 3%

2: 12% (med risk)
3: 25% (high risk)
4: 50% (v high risk)

Question 6

How often should you review the following AREDS scores:
0-1
2
3
4

Answer 6

0-1: 2 years

2: 1 year
3: 6 months
4: 3 months

Question 7

How should you workup an AMD patient? (3)

Answer 7

Measure visual function (VA @ HC + LC; VF - macula)
DFE - look for mac swelling, CNVM
OCT - mac cube or single line through fovea (mac horizontal?)

Question 8

On what OCT results should you refer a AMD patient to a retinal specialist?

Answer 8

Foveal thickness > 300 microns and/or

Central retinal thickness > 350 microns

Question 9

List the 5 OCT signs of CNVM

Answer 9

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