Macula Flashcards
AMD risk factors
- diet low in omega 3 and 6 and carotenoids and minerals is a risk of AMD
- lack of exercise
- smoking
- hypertension
- age
- family history
- AMD in other eye
- high fat diet
Features of dry AMD
- more common
- slowly progressing
- no sudden loss of vision
NICE AMD classifications
Early AMD
- low risk for progression
- medium drusen
- pigmentary abnormalities
Medium risk of progression
- large drusen
- reticular drusen
- medium drusen with pigmentary change
High risk AMD
- large drusen
- reticular drusen with pigmentary change
- viteliform lesion without significant visual loss
- atrophy
Late AMD
- geographic atrophy
- significant visual loss
- dense drusen
- advanced pigmentary changes
- viteliform lesion
Management of dry AMD
- no tx available
- advise on lifestyle
- advise on patients on nutritional supplements
- stop smoking
- second most important risk factor
- promotes ischemia
- reduces macular pigment
Wet AMD features
- less common
- rapid onset
- sudden onset low vision
- referral to ophthalmology
Nice classification of wet AMD
• Late AMD (wet active)
• Classic choroidal neovascularisation (CNV).
• Occult (fibrovascular PED and serous PED with neovascularisation).
• Mixed (predominantly or minimally classic CNV with occult CNV).
• Retinal angiomatous proliferation (RAP).
• Polypoidal choroidal vasculopathy (PCV).
Late AMD inactive features
• Fibrous scar.
• Sub-foveal atrophy or fibrosis secondary to an RPE tear.
• Atrophy (absence or thinning of RPE and/or retina).
• Cystic degeneration (persistent intraretinal fluid or tubulations unresponsive to treatment).
Late AMD wet active
• Classic choroidal neovascularisation (CNV).
• Occult choroidal neovascularisation (CNV).
• Retinal angiomatous proliferation (RAP).
• Fibrous scar.
• Sub-foveal atrophy or fibrosis secondary to an RPE tear.
Wet AMD management NICE
• Make an urgent referral for people with suspected late AMD (wet active) to a macula service, whether or not they report any visual impairment. The referral should normally be made within
1 working day but does not need emergency referral.
• Electronic (via SCI Gateway)
• Via Macular Pathway
• Not usually ‘letter in hand’ same day referral
• Patient needs to be seen at Macular Clinic (where OCT and Fluorescein Angiography are available)
What are vitelliform lesions
- accumulation of lipofuscin within subretinal space
Self monitoring techniques
- amsler
- report changes to optom
NICE management of dry AMD
- usually monitor in community
- refer people with late AMD to hospital to be certified as visually impaired
Rehabilitation steps
- based on adaption to vision loss
- advise on low vision services
- support px in dealing with low vision
- direct to suitable information
HES management of wet AMD
- anti VEGF
- course of 3 injections
- review/monitoring period
- may be discharged by to optometry
- OCT required
