topic 3: ARMD

Question 1

What are the two types of AMD? what is the main characteristic that separates the two?

Answer 1

types:
Atrophic AMD (dry, early stage) 
Exudative AMD (wet, late stage)

wet–usually has neovascularisation

Question 2

what are the 3 signs of RPE hypoxia? what causes it? what is it a pre-requisite for?

Answer 2

Drusen
Choroidal neovascularisation (CNV)
Pigmented epithelial detachment (PED)

Aging causes RPE hypoxia but not everyone experiences it

RPE hypoxia happens before AMD

Question 3

what are 7 symptoms of AMD?

Answer 3

1. Impairment of central vision
2. Metamorphopsia (wavy/ distorted lines)
3. Poor colour vision
4. Delayed photostress recovery (need longer time to recover from bright light exposure)
5. Positive central scotoma
6. Micropsia
7. Macropsia
   objects appear smaller/larger than normal

Question 4

who is at risk of AMD? what are the 8 risk factors?

Answer 4

1. Aged above 50
2. Caucasians
3. Poor diet
4. Family History
5. Obesity
6. Smoking
7. Poorly controlled hypertension and cholesterol
8. Ultraviolet exposure (sun)

Question 5

what are drusens?

Answer 5

Build up of lipofuscin between RPE and Bruch’s membrane

Question 6

what are hard drusens? what are they associated with? what stage of AMD are they seen in?

Answer 6

Small, round, discrete, yellow-white spots

Located on top of Bruch’s membrane
**between RPE and bruch’s membrane

Associated
with RPE dysfunction

seen in In early AMD

Question 7

what are soft drusens? what are they associated with? what stage of AMD are they seen in?

Answer 7

Larger, pale-yellow with indistinct margins
Nearer to RPE

Associated with
ischemia, may
lead to choroidal
neovascularisation

seen in late stage AMD and has high risk of CNV

Question 8

can dry AMD progress into wet AMD? what are their locations and progressions like?

Answer 8

10-20% of individuals: progresses to wet AMD later

Always bilateral but may not progress at the same pace.
possible to have wet type in one eye and the dry type in the other.

Question 9

compare and contrast between wet and dry AMD (how common, development rate, characteristic, severity)

Answer 9

dry more common than wet

dry develops slowly (months) and wet develops rapidly (days)

dry is characterised by the thinning of eye tissues and wet is characterised by bleeding of eye tissues

Dry is less severe compared to wet

Question 10

what are the 4 signs of dry AMD?

Answer 10

1. Focal RPE depigmentation
2. Well defined, circular areas of RPE atrophy
   with photoreceptor loss
3. Enlargement of atrophic areas
4. Geographic atrophy

**IT HAS NO RISK OF RETINAL DETAVHMENT!

Question 11

what are the 3 symptoms of AMD?

Answer 11

1. gradual loss of central vision
2. Central scotoma but NO metamorphopsia
3. Bilateral but asymmetric

Question 12

what is the management for dry AMD

Answer 12

1. educate px about possible progression to Wet AMD
2. Take home Amsler chart, self-check daily
3. EARLY REFERRAL if metamorphopsia observed
4. Advise good lighting
5. Change lifestyle
6. Quit smoking
7. Intake green leafy vegetables / antioxidant
   supplements
8. Exercise regularly
9. Maintain normal BP / cholesterol
10. Follow-up every 3-6 mths

Question 13

what is wet AMD characterized by?

Answer 13

Presence of choroidal neovascularization
(CNV)

risk of retinal detachment

Question 14

what are the 4 signs and symptoms of wet AMD?

Answer 14

1. Soft drusen
2. Metamorphopsia
3. Rapid loss of vision, < 6/60
4. “cannot see faces”
   CP3056

Question 15

what causes CNV? what kind of blood vessels are formed in CNV

Answer 15

Foveal hypoxia causing growth of neovascular membrane

the blood vessels are weak and leak easily hence they may leak and bleed into the eye

Question 16

what kind of damage does leaky blood vessels cause?

Answer 16

Leaky blood vessels may cause SERIOUS/EXUDATIVE RETINAL DETACHMENT

Question 17

how does CNV appear like under ophthalmascopy

Answer 17

1. grey/ green haemorrhage & exudates under retina or
RPE
2. Macular oedema
3. Pigmentation
4. Pigment epithelial detachment (PED)
5. Disciform scar

Question 18

what is the management for wet AMD

Answer 18

1.Urgent referral

2.Require Tx (photodynamic therapy/PDT or
Anti-VEGF) within 72 hours

3. For those with CNV, laser photocoagulation
   can reduce the risk of severe vision loss

VEGF – vascular endothelial growth
factor (stimulates bv growth)

Eg of Anti-VEGF. Avastin, Lucentis
Photodynamic therapy - done by
injecting a light sensitive medicine
called visudyne. The medicine
collects in abnormal BV and laser
will be used to stop the BV growth.

Question 19

LOOOK ATT THHHEEE REFERAL GUIDELINE TABLE BRUH

Answer 19

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