DIS - Macular Diseases II: AMD - Week 1

Question 1

List the 6 components of an AMD work-up.

Answer 1

Measure visual function
Fundus view with mydriasis
Colour fundus photopgraphy
OCT
FAF
Can also do OCTa for CNVM

Question 2

What two things should you look for when doing fundus to assess AMD?

Answer 2

Foveal/macular swelling and CNVM (as well as drusen)

Question 3

What OCT setting should be used to assess AMD?

Answer 3

Macula cube or single line through fovea (just do both)

Question 4

What central retinal thickness on OCT should you refer?

Answer 4

> 350 microns

Question 5

Is early CNVM generally visible on colour fundus photography, BIO, or fundus?

Answer 5

Often noot

Question 6

How should visual function be measured when assessing AMD?

Answer 6

HC + LC VA, and macular VF

Question 7

What is better, macular cube scan or line scan at the macula?

Answer 7

Macula cube

Question 8

What should check on an OCT when assessing AMD?

Answer 8

Check ISe integrity

Question 9

Is identification of CNVM easy or challenging?

Answer 9

challenging

Question 10

How does CNVM appear on colour fundus photography?

Answer 10

Grey/pinkish yellow lesiond

Question 11

What can CNVM lead to? How can this appear on FAF?

Answer 11

RPE detachment (pigment epithelial detachment)
-hypo-fluorescent donut

Question 12

List 5 OCT signs of CNVM. Describe how each appears on the OCT.

Answer 12

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

Question 13

What foveal thickness on OCT is an indication of CNVM?

Answer 13

> 100 microns between the eyes or >350 microns

Question 14

List 5 OCT signs of nascent geographic atrophy. Describe how each appears on the OCT.

Answer 14

Disruption of the ISe
-self-explanatory
Drusen regression
Subsidence of OPL and INL
-drops down
Hyporeflective wedge outer retina
Increased signal below bruchs membrane

Question 15

What does ISe disruption on OCT indicate?

Answer 15

Advanced disease

Question 16

Nascent geographic atrophy is visible by OCT by up to how many months before CFP/FA?

Answer 16

12 months

Question 17

When does geographic atrophy tend to form?

Answer 17

After drusen regression

Question 18

Describe the order of geographic atrophy development on OCT (6).

Answer 18

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

Question 19

What should you do when assessing VA for an AMd work-up?

Answer 19

Pinhole

Question 20

List 3 tests that stress the retina to look for early disfunction.

Answer 20

Low luminance low contrast (LLLC)
Low luminance EDTRS
-with +2ND welding goggles and logMAR
High frequence filtered chart

Question 21

Compare LLLC with HC in terms of line loss.

Answer 21

Normal 1-2 line loss

Question 22

What can abnormal LLLC acuity predict of HC acuity?

Answer 22

HC vision loss by 4 years

Question 23

Describe LLLC acuity in high risk AMD.

Answer 23

Its worse

Question 24

List 5 components of functionally assessing unilateral vision loss when doing an AMD work-up.

Answer 24

Visual acuity
RAPD
Colour vision (R/B)
Flicker sensitivity
Amsler grid

Question 25

What visual field setting should you use to assess AMD?

Answer 25

10-2

Question 26

List 3 additional functional assessment tests for AMD.

Answer 26

Dark adaptation/photostress recovery time test Maddox rod mfERG

Question 27

Describe how maddox rod can be used for AMD assessment. What is this called?

Answer 27

Watzke sign - distortion, gap, or change in line of light when looking at its middle -slit lamp + maddox rod

Question 28

What happens to mfERG with AMD>

Answer 28

Implicit time delayed with retinal disease

Question 29

Is amsler reliable for AMD?

Answer 29

No, consider doing other tests as well -in a study, it only found 30%

Question 30

Is looking for all vision changes reliable for AMD?

Answer 30

No, consider doing other tests as well -in a study, it only found 67%

Question 31

Is OCT reliable for AMD?

Answer 31

Yes, but consider doing other tests as well -in a study, it found all 100%

Question 32

Is dark adaptation reliable for AMD?

Answer 32

Yes, but consider doing other tests as well -in a study, it found 95%

Question 33

Does home monitoring have high or low predictive performance? Describe its role.

Answer 33

Low but allows early detection and early treatment -advise patients to do this with phone/tablet apps

Question 34

At what risk score should OCT be routinely used to assess AMD?

Answer 34

≥1

Question 35

When should AMD be monitored and when is a referral needed (2)?

Answer 35

Monitor until nascent or pre-wet AMD occurs -refer when functional loss or OCT change is established

Question 36

What dietary modification is a therapeutic intervention for what stage of AMD?

Answer 36

Antioxidants for early stages

Question 37

What surgical option s available for AMD? Describe how it affects progression for early AMD and if reticular drusen is present.

Answer 37

Nanosecond laser (like SLT) -gives drusen regression and reduced progression for early AMD -gives progression of AMD if reticular drusen is present

Question 38

What drug is used to treat dry AMD?

Answer 38

None available, being developed

Question 39

What is the intervention for dry AMD?

Answer 39

Low vision aids

Question 40

What are the two interventions for wet AMD? Are both used?

Answer 40

Photodynamic therapy - not used anymore -inject verteporfin, damages local blood vessels when laser activated, seals CNVM aVEGF

Question 41

What happens if CNVM breaks through the RPE?

Answer 41

Sub-retinal fluid accumulation

Question 42

What is retinal angiomatous proliferation? What does it show with early OCT?

Answer 42

Neovascular growth beginning at the inner retina Shows cystic formation early with OCT

Question 43

Where does retinal angiomatous proliferation grow towards and in what stage? What does it look like?

Answer 43

Towards the choroid - looks like CNVM

Question 44

True or false All advanced wet-AMD has retinal angiomatous proliferation.

Answer 44

True

Question 45

Are CNVM and retinal angiomatous proliferation treated the same way?

Answer 45

Yesd

Question 46

Consider an AMD patient being treated with aVEGF who doesnt improve or regress. What now?

Answer 46

Place on another drug

Question 47

Is it likely for vision with AMD to improve with treatment?

Answer 47

Unlikely