Ophthalmology 3 - Age Related Macular Degeneration

Question 1

most common cause of UK blindness

Answer 1

macular degeneration

Question 2

key finding in macular degen fundoscopy

Answer 2

drusen (yellow deposits of proteins and lipids)

appear between retinal pigment epithelium and Bruch’s membrane

larger and more numerous is worse

Question 3

two types of macular degeneration

Answer 3

wet and dry

wet 10% of cases but worse prognosis

Question 4

macular degen common features

Answer 4

drusen
trophy of retinal pigment epithelium
degeneration of photoreceptors

Question 5

wet AMD features

Answer 5

also see new vessels growing from choroid layer to the retina

cause oedema
triggered by VEGF

Question 6

presentation of age related macular degeneration

Answer 6

gradual worsening of central visual field loss

reduced acuity
crooked/wavy appearance to straight lines

much faster presentation (days) with wet type

Question 7

examination findings AMD

Answer 7

reduced Snellen acuity
central scotoma
Amsler grid test (straight lines seem wavy)
fundoscopy drusen
slit lamp confirms 

(for wet AMD can use optical coherence tomography and fluorescein angiography)

Question 8

management of dry AMD

Answer 8

avoid smoking
control blood pressure
vitamin supplements

no specific treatment

Question 9

management of wet AMD

Answer 9

anti VEGF meds

must be started within 3 months of symptoms

e.g. ranibizumab, bevacizumab etc