DIS - Macular Diseases II: AMD - Week 1 Flashcards
List the 6 components of an AMD work-up.
Measure visual function
Fundus view with mydriasis
Colour fundus photopgraphy
OCT
FAF
Can also do OCTa for CNVM
What two things should you look for when doing fundus to assess AMD?
Foveal/macular swelling and CNVM (as well as drusen)
What OCT setting should be used to assess AMD?
Macula cube or single line through fovea (just do both)
What central retinal thickness on OCT should you refer?
> 350 microns
Is early CNVM generally visible on colour fundus photography, BIO, or fundus?
Often noot
How should visual function be measured when assessing AMD?
HC + LC VA, and macular VF
What is better, macular cube scan or line scan at the macula?
Macula cube
What should check on an OCT when assessing AMD?
Check ISe integrity
Is identification of CNVM easy or challenging?
challenging
How does CNVM appear on colour fundus photography?
Grey/pinkish yellow lesiond
What can CNVM lead to? How can this appear on FAF?
RPE detachment (pigment epithelial detachment)
-hypo-fluorescent donut
List 5 OCT signs of CNVM. Describe how each appears on the OCT.
Disruption of the ISe
-self-explanatory
Presence of sub-retinal fluid
-dark bands
Cystic formation within inner retinal layers
-dark bubbles
Pigment epithelial detachment
-clear internal cf drusen (milky)
Increased foveal thickness
What foveal thickness on OCT is an indication of CNVM?
> 100 microns between the eyes or >350 microns
List 5 OCT signs of nascent geographic atrophy. Describe how each appears on the OCT.
Disruption of the ISe
-self-explanatory
Drusen regression
Subsidence of OPL and INL
-drops down
Hyporeflective wedge outer retina
Increased signal below bruchs membrane
What does ISe disruption on OCT indicate?
Advanced disease
Nascent geographic atrophy is visible by OCT by up to how many months before CFP/FA?
12 months
When does geographic atrophy tend to form?
After drusen regression
Describe the order of geographic atrophy development on OCT (6).
Disruption of the ISe
Drusen regression
Subsidence of OPL and INL
Hyporeflective wedge outer retina
Increased signal below bruchs membrane
Complete loss of OS/RPE
-geographic atrophy
What should you do when assessing VA for an AMd work-up?
Pinhole
List 3 tests that stress the retina to look for early disfunction.
Low luminance low contrast (LLLC)
Low luminance EDTRS
-with +2ND welding goggles and logMAR
High frequence filtered chart
Compare LLLC with HC in terms of line loss.
Normal 1-2 line loss
What can abnormal LLLC acuity predict of HC acuity?
HC vision loss by 4 years
Describe LLLC acuity in high risk AMD.
Its worse
List 5 components of functionally assessing unilateral vision loss when doing an AMD work-up.
Visual acuity
RAPD
Colour vision (R/B)
Flicker sensitivity
Amsler grid
What visual field setting should you use to assess AMD?
10-2
List 3 additional functional assessment tests for AMD.
Dark adaptation/photostress recovery time test
Maddox rod
mfERG
Describe how maddox rod can be used for AMD assessment. What is this called?
Watzke sign - distortion, gap, or change in line of light when looking at its middle
-slit lamp + maddox rod
What happens to mfERG with AMD>
Implicit time delayed with retinal disease
Is amsler reliable for AMD?
No, consider doing other tests as well
-in a study, it only found 30%
Is looking for all vision changes reliable for AMD?
No, consider doing other tests as well
-in a study, it only found 67%
Is OCT reliable for AMD?
Yes, but consider doing other tests as well
-in a study, it found all 100%
Is dark adaptation reliable for AMD?
Yes, but consider doing other tests as well
-in a study, it found 95%
Does home monitoring have high or low predictive performance? Describe its role.
Low but allows early detection and early treatment
-advise patients to do this with phone/tablet apps
At what risk score should OCT be routinely used to assess AMD?
≥1
When should AMD be monitored and when is a referral needed (2)?
Monitor until nascent or pre-wet AMD occurs
-refer when functional loss or OCT change is established
What dietary modification is a therapeutic intervention for what stage of AMD?
Antioxidants for early stages
What surgical option s available for AMD? Describe how it affects progression for early AMD and if reticular drusen is present.
Nanosecond laser (like SLT)
-gives drusen regression and reduced progression for early AMD
-gives progression of AMD if reticular drusen is present
What drug is used to treat dry AMD?
None available, being developed
What is the intervention for dry AMD?
Low vision aids
What are the two interventions for wet AMD? Are both used?
Photodynamic therapy - not used anymore
-inject verteporfin, damages local blood vessels when laser activated, seals CNVM
aVEGF
What happens if CNVM breaks through the RPE?
Sub-retinal fluid accumulation
What is retinal angiomatous proliferation? What does it show with early OCT?
Neovascular growth beginning at the inner retina
Shows cystic formation early with OCT
Where does retinal angiomatous proliferation grow towards and in what stage? What does it look like?
Towards the choroid - looks like CNVM
True or false
All advanced wet-AMD has retinal angiomatous proliferation.
True
Are CNVM and retinal angiomatous proliferation treated the same way?
Yesd
Consider an AMD patient being treated with aVEGF who doesnt improve or regress. What now?
Place on another drug
Is it likely for vision with AMD to improve with treatment?
Unlikely
