Macular degeneration

Question 1

What is the macula?

Answer 1

Centre of the retina

Fovea centralis

Where the retina just consists of cones

Question 2

What’s the difference between rods and cones?

Answer 2

Cones = colour vision (C, C)

Rods = black and white (Rod Stewart has grey hair)

Question 3

Two types of age-related macular degeneration (AMD)?

What’s the difference in pathophysiology and presentation?

Answer 3

Dry:

Degenerative change, atrophy of retina + drusen

Slower onset and progression

Wet:

Aberrant vessel growth from choroid into neuro-sensory retina, they then leak below retina, localised retinal detachment and scarring

More rapid loss of vision

Question 4

What is the first sign of ageing in the retina?

Answer 4

Development of Drusen

Mitochondiral calcification, extruded into extra-cellular space

The calcified bits are the drusen

Question 5

Clinical features of dry AMD?

Answer 5

Central scotoma: patches of damage which result in visual loss

Good peripheral vision

Deterioration to blindness

Question 6

What is seen on fundoscopy with dry AMD?

Answer 6

Optic disc yellow and lumpy

Absent optic cup

Drusen

Question 7

Management of dry AMD?

Answer 7

None
Lifestyle changes can slow progression
- stop smoking
- healthy diet (green veg)
- dietary supplements

Question 8

Clinical features of wet AMD?

Answer 8

Rapid change in vision

Objects become smaller (micropsia) or distorted

Central visual blurring and distortion

Profound central visual loss in event of bleed
preceded by shower of floaters

Question 9

What is seen on opthalmoscopy in wet AMD?

Answer 9

Exudates and haemorrhages

Retinal scarring + detachment

Question 10

Management of wet AMD?

Answer 10

Photodynamic laser treatment
After IV injection of a photosensitive drug (verteporfin)

Intra-vitreal injection vascular endothelial growth factor (VEGf) inhibitor (bevacizumab)