Unit 4 - AMD

Question 1

What are the 6 clinical signs of AMD?

Answer 1

1. Drusen
2. RPE Changes
3. GA, absence of RPE
4. PED
5. CNVM
6. Fibroglial scar

Question 2

How many cases of AMD are genetically determined?

Answer 2

1/4

Question 3

If you have an older sibling with AMD how much more likely are you to develop AMD?

Answer 3

3-6X

Question 4

If you have more than 8 hours sunlight exposure per day are you more likely to get dry AMD?

Answer 4

Yes

Question 5

What is the incidence of end stage AMD in the over 40 population

Answer 5

1.5%

Question 6

What are the indications for urgent referral of wet AMD?

Answer 6

Recent onset:

• reduced v/a,
• Metamorphopsia,
• Scomota or blind spot,

V/a better than 6/60

And/Or Haem Fluid on OCT Exudates

Question 7

Once GA commences how long is the average progression to legal blindness?

Answer 7

5-9 years

Question 8

What % of dry patients will develop wet?

Answer 8

10-15%

Question 9

What is the differential diagnosis in dry AMD?

Answer 9

1. Dominant drusen
2. Stargadt’s
3. Pathological myopia
4. Maternally inherited deafness and diabetes

Question 10

What are the clinical features of dominant drusen?

Answer 10

1. Symmetrical drusen
2. More drusen seen on FFA and FAF than obvserved
3. Family history
4. V/a will usually be oK but more likely to develop AMD

Question 11

Why is the retina so prone to oxidative stress?

Answer 11

1. High oxygen consumption
2. Concentration of polyunsaturated fatty acids
3. Exposure to sunlight

Question 12

What antioxidants were used in AREDS 1?

Answer 12

1. Vitamin C
2. Vitamin E
3. Vitamin A Betacrotene 15mg
4. Zinc
5. Copper

Question 13

What changes were made in AREDS 2?

Answer 13

Removed Betacarotene and added lutein and zeaxanthin

Question 14

What benefit was found in ARED2 compared to AREDS1?

Answer 14

20%

Question 15

Did Omega 3 give any additional benefit?

Answer 15

No

Question 16

What problems are there with betacarotene?

Answer 16

Increased risk of lung cancer in smokers in doses > 20mg/day

Question 17

What size are small and intermediate drusen?

Answer 17

Small <63microns

Intermediate 63-125 microns

Question 18

Where are type 2/ classic CNVM

Answer 18

Penetrating RPE into retina

Question 19

What are the complications of wet AMD

Answer 19

1. Serous retinal detachment
2. Haem
3. Progression of GA
4. Subretinal fibrosis
5. Charles Bonnet syndrome
6. Low vision = depression, falls, fractures, loss of driving licence and lower qol

Question 20

What is retinal angiomatous proliferation?

Answer 20

Subset of wet AMD but when proliferation occurs from retinal capillaries.

Starts intra-retinally and may go sub-retinal and then into choroidal

Question 21

How do patients with RAP differ from traditional wet AMD patients?

Answer 21

Maybe be older and lesions are usually bilateral and juxtafoveal.

Question 22

Does RAP respond to anti-VEGF?

Answer 22

Partially

Question 23

What is ICPV?

Answer 23

Idiopathic choroidal polypoidal vasculopathy, a variant of wet AMD

Question 24

How are ICPV patients different from traditional wet AMD patients?

Answer 24

Usually younger and asian

Question 25

What other causes of CNVM are there? (5)

Answer 25

1. Myopia
2. Trauma
3. Inflammation
4. Angiod streaks
5. Tumours

Question 26

What other causes of fluid leaks are there? (2)

Answer 26

• Central serous chorioretinopathy
• Optic disc pits

Question 27

Which inherited macula dystrophies can mimic wet AMD?

Answer 27

• Sorsby macula degeneration
• Adult vitelliform dystrophy