Dry age related macular degeneration (AMD) and Visual Field Defects

Question 1

Age-related macular degeneration is the most common cause of blindness in the UK. What is the incidence of this?

1 - 11000 cases per 100,000
2 - 1100 cases per 100,000
3 - 110 cases per 100,000
4 - 11 cases per 100,000

Answer 1

3 - 110 cases per 100,000

Equally likely in men and women

Question 2

What age does the incidence of age-related macular degeneration typically peak?

1 - >80
2 - >70
3 - >60
5 - >50

Answer 2

2 - >70

Question 3

Although the peak incidence of age-related macular degeneration typically peaks at 70 years old, what age can this occur from?

1 - >30
2 - >40
3 - >50
4 - >60

Answer 3

3 - >50

Question 4

Which of the following is NOT a typical risk factor for developing age-related macular degeneration?

1 - advancing age
2 - smoking
3 - thyroid dysfunction
4 - family history
5 - comorbidity associated with ischaemia (CVD, hypertension, diabetes and dyslipidaemia

Answer 4

3 - thyroid dysfunction

Advancing age is the biggest risk factor

Question 5

There are 2 types of age-related macular degeneration:

• dry macular degeneration
• wet macular degeneration

Which of these accounts for 90% of all age-related macular degeneration?

Answer 5

• dry macular degeneration

Question 6

There are 2 types of age-related macular degeneration:

• dry macular degeneration
• wet macular degeneration

Which of the 2 has the worse prognosis?

Answer 6

• wet macular degeneration

Question 7

Which of the following is NOT a feature of dry macular degeneration?

1 - accounts for 90% of cases
2 - also referred to as atrophic
3 - characterised by drusen - yellow round spots in Bruch’s membrane
4 - carries the worst prognosis

Answer 7

4 - carries the worst prognosis

Drusens are focal yellow or white deposits of extracellular debris located between the retinal pigment epithelium (RPE) and Bruch’s membrane.

Drusens are bi-products of oxidation, typically removed by macrophages, but as we age bi-products build up forming drusens

Question 8

What can we see in the image below?

1 - hard exudate formation
2 - drusen on macula
3 - cotton wool spots
3 - haemorrhage of newly formed blood vessels

Answer 8

2 - drusen on macula

Because they are on the macula this can impair vision

Question 9

Which of the following is NOT a feature of wet macular degeneration?

1 - accounts for 10% of cases
2 - also referred to as atrophic
3 - characterised by choroidal neovascularisation
4 - leakage of serous fluid and blood can subsequently result in a rapid loss of vision
5 - carries the worst prognosis

Answer 9

2 - also referred to as atrophic

Actually referred to as exudative or neovascular macular degeneration

Question 10

Does age-related macular degeneration typically occur insidiously or have a gradual onset?

Answer 10

• gradual onset

Typically patients do not present with symptoms of pain or anything similar to that

Question 11

In age-related macular degeneration, which of the following do patients typically complain of?

1 - blurry central vision
2 - difficulty reading
3 - recognising faces
4 - difficulties in dark adaptation
4 - fluctuations in visual disturbance
5 - photopsia, (perception of flickering or flashing lights), and glare around objects
6 - all of the above

Answer 11

6 - all of the above

Question 12

Which of the following imaging techniques is NOT typically used to diagnose and stage age related macular degeneration?

1 - slit-lamp microscopy
2 - ultrasound of the eye
3 - optical Coherence Tomography (OCT)
4 - fluorescein angiography

Answer 12

2 - ultrasound of the eye

Question 13

Although there is no effective curative treatment for age related macular degeneration, which of the following has been shown to slow progression by 1/3?

1 - steroids
2 - zinc with vitamins A, C and E
3 - lifestyle change
4 - anti-VEGF agents
5 - laser photocoagulation

Answer 13

2 - zinc with vitamins A, C and E
- only in dry age related macular degeneration

In wet age related macular degeneration, anti-VEGF can slow severe disease progression

Question 14

Patients with dry age related macular degeneration (AMD) can be given an Amsler grid to monitor what?

1 - monitor response to changed glasses
2 - transformation to wet AMD which can cause rapid central vision loss
3 - transformation to glaucoma
4 - transformation to cataracts

Answer 14

2 - transformation to wet AMD
- important as this can cause rapid central vision loss

Question 15

In patients with visual field defects, which have been detected by an opticians for example, does the eye typically have any obvious pathology?

Answer 15

• no

Eye appears normal, but defect identified doing visual field checks

Question 16

Once a visual field defect has been identified, in an otherwise healthy eye, what test needs to be performed in an attempt to identify the cause of the visual defect?

1 - fundoscopy
2 - split lamp exam
3 - neuroimaging
4 - all of the above

Answer 16

3 - neuroimaging

Question 17

Which of the following is the most common cause of a field defect, where the eye appears healthy?

1 - cerebral vascular accident (stroke)
2 - T2DM
3 - cerebral haemorrhage
4 - infection

Answer 17

1 - cerebral vascular accident (stroke)

Common for patients to present with weakness on one side of the body and other ocular signs

Question 18

Which of the following is NOT a risk factor for developing a cerebral vascular accident (stroke) that can lead to visual defects?

1 - hypertension
2 - diabetes
3 - female gender
4 - hypercholesteremia

Answer 18

3 - female gender

Question 19

Which of the following imaging methods is used to detect a cerebral vascular accident (stroke) that can lead to visual defects?

1 - head CT
2 - head X-ray
3 - head PET
4 - head MRI

Answer 19

1 - head CT

Question 20

If a visual field defect in a patient with a suspected cerebral vascular accident (stroke) occurrs with a greater congruency (equally affecting both eyes), does this suggest the lesion is further forward or back in the vidsual pathway (see image below)?

Answer 20

• further forward

Question 21

The pituitary gland sits just underneath the optic chiasm, so any pituitary adenomas may cause visual field defects in an otherwise health eye. What size does the pituitary adenoma have to be before it compresses the optic chiasm?

1 - >2mm
2 - >5mm
3 - >10mm
4 - >20mm

Answer 21

3 - >10mm

If pituitary tumour is suspected then neuroimaging and blood tests are required (hormones etc)

Question 22

If a pituitary adenoma is >10mm, which of the following field defects is this associated with?

1 - mononuclear vision loss
2 - bitemporal hemianopia
3 - contralateral homonymous hemianopia
4 - contralateral superior quadrantopia

Answer 22

2 - bitemporal hemianopia

If pituitary tumour is suspected then neuroimaging and blood tests are required (hormones etc)