Macular Degeneration - Jack Flashcards
Age-Related Macular Degeneration
- leading cause of severe central visual acuity loss
- chronic disease
- 2 types - Non-Exudative (Dry) and Exudative (Wet)
Risk Factors for AMD
age
hyperopia
smoking
low HDL and high LDL
familial history (parents > sibling)
Features of Non-Exudative (dry) AMD
drusen
focal hyperpigmentation
retinal pigment epithelieum atrophy
Drusen
small or large, round, yellow lesions - between the retinal pigment epithelium basement membrane and Bruch’s membrane
AERDS Supplementation in AMD
greatest reduction in conversion to advanced AMD
- lutein/zeaxanthine
- recommend AREDS 2 over AREDS 1
- anti-oxidants + zinc + copper
- zinc + copper alone
- anti-oxidatnts alone
Management of Non-Exduative (Dry) AMD
40-64: 2 year exam
>65: 1-2 year exam
Daily Amsler Grid Monitoring
AREDS 2 Eye Vitamins - Vitamin C, E, Lutein/Zeaxanthine, Zinc, and Copper
Lifestyle modification - smoking cessation, optimize diet, exercise
What is being monitored for, using the Amsler Grid?
sudden decreased vision
Metamorphosia: distorted vision in which a grid of straight lines appears wavy
Sctoma: shadows of missing areas of vision
Blurring
Features of Exudative (wet) AMD
chorodial neovascularization
break in Bruch’s membrane that allows new blood vessels to grow into the sub-RPE space
the vessels leak fluid, lipid, blood under the RPE and subretinally
can cause subretinal fibrotic scar formation
Management of Exudative (Wet) AMD
Anti-VEGF Drugs - Ranibizumab, Aflibercept (+PIGF)
Older therapies that have fallen out of favor: laser photocoagulation, photodynamic therapy
Anti-VEGF treatment
recombinant humanzied antibody fragments
one of the first therapies to stabilize and improve vision: can gain 6-9 letters instead of losing 23 letters
