Macular Degeneration

Question 1

What’s the size of a large druse?

Answer 1

> 125um or the size of a vein coming out of ON head

Question 2

What’s the percentage of ppl with dry and wet AMD?

Answer 2

Dry - 90%

Wet - 10%

Question 3

What’s the main treatment plan if both eyes have early AMD?

Answer 3

• No AREDs
• Take Lutein and Zeaxanthin supplements
• Eat colorful Vegetables
• No smoking
• Lose weight/exercise

Question 4

What VEG-F injection is the best to use? Why?

Answer 4

Eyelea

- goes after placental growth factor

Question 5

What type of inflammation is found in AMD?

Answer 5

Complement

Question 6

What happens to bruch’s membrane while you age? why is this a problem?

Answer 6

BM gets thicker; drusen can’t escape = causes RPE detachment

Question 7

If genetic testing reveals complement factor H, what’s the tx plan?

Answer 7

Antioxidant supplements only

Question 8

Complement system is activated by what?

Answer 8

CRP and lipofuscin

Question 9

What percentage of caucasians express Complement factor H?

Answer 9

40%

Question 10

Which VEG-F isoform is responsible for ocular neovascularization?

Answer 10

165

Question 11

Which genetic factor is responsible for cholesterol metabolism?

Answer 11

ABCA1 gene

Question 12

Which genetic factor is responsible for protection from oxidative stress in mitochondria?

Answer 12

ARMS2

Question 13

Which genetic factor is responsible for breaking down bruch’s membrane to allow drusen to get through?

Answer 13

TIMP3

Question 14

The more ____ that an individual has, the greater risk of AMD.

Answer 14

SNPS (Single Nucleotide Polymorphism)

Question 15

The Beaver Dam Eye Study said what percentage of people aged 75 and older have some form of AMD? What percentage have the advanced form?

Answer 15

30%

7%

Question 16

How many americans are considered “at risk” for developing advanced AMD in the next 5 years?

Answer 16

8 million

Question 17

How many americans are currently affected with the advanced form?

Answer 17

1. 75 million

- will increase to 3 million by 2020

Question 18

What percentage of wet AMD cases have severe vision loss?

Answer 18

90%

Question 19

If genetic testing revealed the ARMS2 gene, how would you treat them?

Answer 19

Zinc supplements only

Question 20

What ocular findings are associated with dry AMD?

Answer 20

1. Drusen
2. RPE clumping
3. RPE Atrophy

Question 21

Early AMD is classified as:

Answer 21

1. > 125um of drusen
2. Pigmentation
3. at least 1 intermediate size druse (63-125um)

Question 22

What percentage of early AMD patients will progress to advanced by year 5?

Answer 22

1.3%

Question 23

Intermediate AMD is classified as:

Answer 23

1. Inter. Drusen w/in 1/5 of disc area
2. Large number of druse (>125um)
3. Non-central GA

Question 24

What percentage of intermediate AMD patients progress to advanced by year 5?

Answer 24

18%

Question 25

What's the tx plan for intermediate AMD?

Answer 25

AREDs formula, see them 4x a year

Question 26

Advanced AMD is classified as:

Answer 26

1. CNVM | 2. Foveal Geographic Atrophy

Question 27

Will AREDs work for an advanced AMD patient?

Answer 27

No, start on injections

Question 28

What's the average size of a CNVM? How fast does it grow a day?

Answer 28

``` Ave = 3000-3300um Growth = 10-20um a day ```

Question 29

Advanced AMD is associated with what type of death?

Answer 29

Cardiovascular death

Question 30

A classic CNVM looks like what? what's the FA look like?

Answer 30

Well-demarcated areas, FA looks defined

Question 31

An occult CNVM will have what type of FA?

Answer 31

Slow leak on angiography w/ diffuse ooze

Question 32

80% of eyes w/ CNVM will have what type of vision?

Answer 32

worse than 20/40

Question 33

What are the unfavorable prognostic signs leading to CNVM

Answer 33

1. Soft, large drusen 2. Hyperpigmentation 3. disciform lesion in fellow eye 4. Old age

Question 34

AREDS I has beta carotene which is not good for what group of ppl?

Answer 34

Smokers

Question 35

does laser photocoagulation of soft drusen stop the progresison of AMD?

Answer 35

No, not useful

Question 36

If we want to reduce CRP and IL-6 levels, what medications are suggested?

Answer 36

Lipitor Zocor Norvir

Question 37

What is the earliest detectable sign of AMD?

Answer 37

Drusen

Question 38

The complement cascade system is associated with what 5 factors?

Answer 38

1. Factor H 2. Factor I 3. C3 4. C2 5. Factor B

Question 39

For the complement factor H gene, tyrosine is replaced with a histidine at position 402 increasing the risk of AMD ~ ___-fold

Answer 39

5-fold

Question 40

Genetic testing is great at predicting ____, but weak at predictin ____

Answer 40

Great at ARMD | Weak at CNVM

Question 41

If a patient has CFH and ARMS2 alleles, will AREDS work?

Answer 41

No

Question 42

Clinical depression is found in what fraction of patients?

Answer 42

1/3