Macular Degeneration

Question 1

What is macular degeneration?

Answer 1

Degeneration in the macula which causes progressive visual deterioration -> most common cause of blindness in the UK

Question 2

What are the 2 types of MD?

Answer 2

Wet - Worse prognosis
Dry - More common

Question 3

What is the structure of the macula?

Answer 3

1. Choroid layer at bottom which has blood supply
2. Bruch’s membrane
3. Retinal pigment epithelium
4. Photoreceptors

Question 4

What are features of both wet and dry MD?

Answer 4

• Atrophy of the retinal pigment epithelium
• Degeneration of the photoreceptors
• Greater/Larger Drusen (yellow deposits of protein lipid between layers 3 and 4)

Question 5

What is a key feature of wet MD?

Answer 5

• Development of new vessels from the choroid layer into the retina which cause oedema and more rapid visual loss

Question 6

What are risk factors for MD?

Answer 6

• Age
• Smoking
• White/Chinese origin
• FH
• CV disease

Question 7

How does MD present?

Answer 7

• Gradual worsening central visual field loss
• Reduced acuity
• Straight lines appear crooked/wavy
• Wet presents more acutely

Question 8

What are examination findings of MD?

Answer 8

• Reduced acuity
• Scotoma (central patch of vision loss)
• Drusen on Fundoscopy

Question 9

How is MD investigated?

Answer 9

• Slit lamp exam
• Optical coherence tomography - used to diagnose Wet
• Fluorescein angiography to detect oedema and neovascularization (used second line to diagnose wet MD)
• -amsler grid

Question 10

How is Dry MD managed?

Answer 10

• No specific treatment
• Lifestyle measures including modify risk factors, vitamin supplementation

Question 11

How is Wet MD managed?

Answer 11

• Anti-VEGF medications which block VGEF to stop neovascularisation e.g. Ranibizumab
• Can slow and even reverse damage
• Photodynamic therapy
• laser photocoagulation