MACULAR DEGENERATION Flashcards
What proportion of the UK are affected by age related macular degeneration?
10%
It is the largest single cause of blind registration in the Western World.
What is the macula of the retina?
Oval pigmented central area of the retina which contains the fovea.
What part of the retina is affected by age related macular degeneration?
Retinal pigment epithelium with secondary neural retinal degeneration
What are the risk factors for developing age related macular degeneration?
Age: over 60
Smoking
Hypertension
Family history
Caucasian
High cumulative sunlight exposure
Female sex
Obesity and high cholesterol
What is the traditional way of classifying age related macular degeneration?
Dry (also called geographic atrophy)
Wet (also called exudative or neovascular)
What are the features of dry age related macular degeneration?
Gradual central visual loss over years
Drusen spots across the retina (not just over the macula)
Pigment clumping
Macular atrophy
What are drusen spots?
Yellow round spots in Bruch’s membrane
What percentage of people with age related macular degeneration have the dry type?
90%
What are the features of wet age related macular degeneration?
Sudden central visual loss or distortion
Subfoveal choroidal neovascular membranes
Subretinal haemorrhage
Subretinal fluid collection causing pigment epithelial detachment
Which type of age related macular degeneration carries a worse prognosis?
Classically wet AMD however, there is no cure for dry AMD whereas wet can sometimes be treated.
More recently there has been a move away from the straight split between wet and dry age related macular degeneration. How has it been reclassified?
Early - with gradual build up of drusen and small alterations to the RPE
Late - with late being split into dry or wet
What further investigations might you do for someone who has features consistent with age related macular degeneration on fundoscopy?
Optical coherence tomography - provides cross sectional views of the macula
Fluorescein angiogram - detect and delineate a neovascular membrane and leakages
How do we manage someone with dry age related macular degeneration?
Stop smoking
High dose of beta-carotene, vitamins C and E, and zinc may help to slow down visual loss for patients with established macular degeneration
In which patients are supplements contraindicated in the treatment of dry age related macular degeneration?
Heavy smokers - increased risk of lung cancer
How do we manage someone with wet age related macular degeneration?
Photocoagulation
Photodynamic therapy - ‘cold’ laser treatment
VEG-F - anti-vascular endothelial growth factor: intravitreal ranibizumab
Intra- or peri-ocular steroid use.
