RETINA - MACULAR RETINOPATHIES Flashcards
what is AMD?
it is a progressive disease defined by the presence of drusen in the macula 2/2 a deteriorated RPE, bruch’s membrane, and choriocapillaris.
what are risk factors for AMD?
- age (>65)
- ethinicity (caucasians)
- FHx
- smoking (2.5x)
- sun exposure
- low leafy green diet
- HTN / high cholesterol
what symptoms of AMD?
- blurry vision
- central scotoma
- metamorphopsia
what are the stages of dry AMD?
- Category 1 – very mild dry AMD: Defined by the presence of <5 small (<63 microns) drusen.
- Category 2 – Early AMD: characterized by presence of: Multiple small drusen / Few intermediate (63- 124 microns) drusen / Mild pigment abnormalities / Or a combination of these
- Category 3 – Intermediate AMD: characterized by the presence of: Numerous intermediate drusen &/OR At least one large drusen (>125 microns) &/OR Geographic atrophy that does NOT involve the center of the fovea.
- Category 4 – advanced AMD: defined by the presence of geographic atrophy in the center of the fovea in one eye.
at what stage is dry AMD treated? with what?
stage 3 - intermediate stage.
treated with AREDS2
what are signs of wet AMD?
- classified by the prescence of choroidal neovascularization (CNVM) in the sub-RPE or subretinal space. –> can cause a PED, serous detachment, heme.
- mixture of small, hard drusen and large, soft drusen in the macula.
tx for dry AMD?
- AREDS 2 if intermediate stage or above
- AMSLER grid for self home check.
- yearly check for early - mild AMD.
- 6 months check for moderate - severe.
tx for wet AMD?
Tx aimed at controlling CNVM:
* Subfoveal and nonsubfoveal CNVM –> focal laser photocoagulation or anti-VEGF (SOC).
- F/U – monthly until CVNM is inactive based on IVFA and/or OCT.
what is the standard of care for wet AMD tho?
Standard of Care for WET AMD –> Anti-VEGF
* Lucentis - approved for tx of AMD
* Eylea - Approved for AMD
* Avastin - not approved for AMD, off-label –> Just as good & cheaper
what is CSR?
it is accumulation of macular subretinal fluid.
who most commonly is impacted by CSR?
- young - middle aged (20-50) men w/ type A personality.
- under stress
what risk factors is CSR associated with?
- stress
- pregnancy
- steroid use
symptoms of CSR?
- Unilateral sudden onset of blurred vision (20/20 –> 20/200).
- Metamorphopsia
- Micropsia
- Central scotoma
signs of CSR?
- OCT –> serous retinal detachment of neurosensory retina in the macula – absence of blood or lipid exudates.
- FA –> “smokestack” sign - which is pooling of fluorescein into RPE detachment.
tx for CSR?
- No tx, will resolve within 1-3 months – VA usually improves to at least 20/30 or better.
- D/C steroids (topical/nasal/oral) if possible.
- Laser can speed up resolution but not improve final visual outcome.
- Educate pt that recurrence is common (yearly).
- F/U –> monitor every 6-8 wks until resolution.
