Exam 2: AMD Overview and Diagnosis

Question 1

True or false: AMD is the second most common cause of vision loss in the elderly in the developed world.

Answer 1

False; it is THE most common cause of vision loss in the elderly in the developed world.

Question 2

What gender and race is more common among AMD patients?

Answer 2

Female, Caucasian

Question 3

Which type of ocular pigmentation increases the likelihood of AMD development, light or heavy?

Answer 3

Light.

Question 4

What two genes were mentioned in Dr. Erickson’s slides as being a component of AMD development?

Answer 4

ARMS2 and CFH

Question 5

What are some of the modifiable risk factors for AMD?

Answer 5

Smoking (2.5x risk for current smoker, 1.3x for former smoker), phototoxicity, weight, blood pressure, macular pigment density.

Question 6

The macula is about ____mm in diameter. The fovea is about ____mm in diameter, and the foveola is about ____mm in diameter.

Answer 6

Macula: ~5.5mm
Fovea: ~1.5mm
Foveola: ~0.35

Question 7

The RPE has a _____ (strong/weak) adhesion to Bruch’s membrane and a _____(stronger/weaker) adhesion to the sensory retina.

Answer 7

The RPE has a strong adhesion to Bruch’s membrane and a weaker adhesion to the sensory retina.

Question 8

In early AMD, what size are the drusen? How much is VA affected?

Answer 8

Drusen: medium sized
VA: not usually affected

Question 9

In intermediate AMD, what size are the drusen? Though the VA may or may not be affected, what can be seen, due to changes in the RPE?

Answer 9

Drusen: large
RPE changes: hyperplasia or hypertrophy can cause pigment changes. There can also be a Pigment Epithelial Detachment (PED)

Question 10

Advanced AMD can be either dry or wet. What is another term for dry advanced AMD?

Answer 10

Geographic atrophy

Question 11

Advanced AMD can be either dry or wet. What changes can be seen in wet advanced AMD?

Answer 11

Hemorrhagic RPE or sensory detachment, vitreous hemorrhage, and disciform scarring.

Question 12

Which form of AMD is most common, dry or wet?

Answer 12

Overall, dry is more common. 10-20% of early/intermediate dry AMD proceeds to advanced AMD. Of the cases that progress to advanced AMD, 80% go on to wet advanced, and 20% go on to dry advanced.

Question 13

RPE atrophy indicates a _____ (higher/lower) risk of CNV.

Answer 13

Higher risk of CNV

Question 14

Between what layers would you find drusen?

Answer 14

Between the basement membrane of the RPE and the inner collagenous zone of Bruch’s membrane

Question 15

Small hard drusen are less than 63 microns in size and feature _____ (well-defined/fuzzy) borders. How can you judge the size of a drusen?

Answer 15

Borders: well-defined
Size: compare to the size of vessels leaving the optic disc; these vessels are about 125 microns.

Question 16

True or false: the presence of small hard drusen is sufficient to make a diagnosis of AMD.

Answer 16

False; cannot make the diagnosis based on small hard drusen alone.

Question 17

Soft drusen have fluffier borders than hard drusen. What is the difference, size-wise, between intermediate soft drusen and large soft drusen?

Answer 17

Intermediate: 63-124 microns
Large: >124 microns

Question 18

Large soft drusen increase the risk for developing RPE abnormalities, geographic atrophy, and CNV.

Answer 18

Free card.

Question 19

True or false: the presence of large soft drusen is sufficient to make a diagnosis of AMD.

Answer 19

True.

Question 20

Do soft drusen typically hyperfluoresce or hypofluoresce with FA?

Answer 20

They typically hyperfluoresence early, and then either fade or stain late.

Question 21

Familial drusen exhibit an autosomal ______ (dominant/recessive) pattern and are typically present earlier in life.

Answer 21

Autosomal dominant pattern

Question 22

True or false: familial drusen may extend nasal of the disc

Answer 22

True.

Question 23

Calcific drusen are left behind as a result of long-standing _____ (soft/hard) drusen and tend to have a glistening appearance.

Answer 23

Soft drusen.

Question 24

A Pigment Epithelial Detachment can be caused by drusen, accumulation of fluid, or fibrovascular tissue. If a sensory retinal detachment is present as well as a PED, this could indicate CNV.

Answer 24

Free card.

Question 25

PED in a/an _______ (younger/older patient) has a greater chance of developing CNV, as does a _______ (larger/smaller) PED.

Answer 25

Older patient; larger PED.

Question 26

How would a PED show on FA?

Answer 26

Gradual and uniform staining

Question 27

What percentage of individuals over the age of 75 develop AMD?

Answer 27

~30%

Question 28

Of the individuals over the age of 75 that have AMD, what percentage are dry AMD (early or intermediate stage)? Late stage AMD?

Answer 28

Early/intermediate: 80-90%

Late: 10-20%

Question 29

In late AMD, what percentage have wet/exudative? Dry/nonexudative?

Answer 29

Wet: 80%
Dry: 20%

Question 30

How many patients with geographic atrophy progress to wet AMD?

Answer 30

10-20% (due to CNV)

Question 31

What sorts of subjective complaints might a patient with nonexudative AMD have?

Answer 31

Gradual mild to moderate vision impairment, which is more noticeable during near tasks; changes with night vision or changing light conditions

Question 32

With dry AMD, RPE changes can be seen in the retina. True or false: early on, metamorphopsia and central vision loss are both present in this form of AMD.

Answer 32

False; metamorphopsia and central vision loss are not usually features of early dry AMD.

Question 33

Why is central vision often spared in the early stages of nonexudative AMD?

Answer 33

Xanthophyll pigment in the fovea acts as a protective agent; however, central vision may be eventually lost to geographic atrophy.

Question 34

Early dry AMD can be identified by several small drusen or a few medium drusen, and has no obvious symptoms or vision loss. Intermediate dry AMD, however, features many medium drusen or one or more large drusen. What sorts of symptoms might be be present in this stage?

Answer 34

Blurred vision or blind spot, metamophopsia, decreased contrast sensitivity. The patient may be asymptomatic though.

Question 35

Advanced dry AMD features drusen similar to intermediate dry AMD, but also involves a breakdown of photoreceptors and the surrounding macular tissue. What sorts of symptoms might be be present in this stage?

Answer 35

Larger blind spot, more severe metamorphopsia, possibly encompassing entire center field

Question 36

What clinical tests could be run for a patient with dry AMD?

Answer 36

Fundus examination, color fundus photography, Amsler grid, photostress testing, color vision testing, central 10 perimetry, OCT, PHP, FA.