Unit 4 - AMD Flashcards
What are the 6 clinical signs of AMD?
- Drusen
- RPE Changes
- GA, absence of RPE
- PED
- CNVM
- Fibroglial scar
How many cases of AMD are genetically determined?
1/4
If you have an older sibling with AMD how much more likely are you to develop AMD?
3-6X
If you have a first degree relative with AMD how much more likely are you get AMD?
4X
If you have more than 8 hours sunlight exposure per day how much more likely are you to get dry AMD?
5X
What is the incidence of end stage AMD in the over 40 population
1.5%
What are the indications for urgent referral or wet AMD?
Recent onset:
- reduced v/a,
- Metamorphopsia,
- Scomota or blind spot,
V/a better than 6/60
And/Or Haem Fluid on OCT Exudates
Once GA commences how long is the average progression to legal blindness?
5-9 years
What % of dry patients will develop wet?
10-15%
What is the differential diagnosis in dry AMD?
- Dominant drusen
- Stargadt’s
- Pathological myopia
- Maternally inherited deafness and diabetes
What are the clinical features of dominant drusen?
- Symmetrical drusen
- More drusen seen on FFA and FAF than obvserved
- Family history
- V/a will usually be oK but more likely to develop AMD
Why is the retina so prone to oxidative stress?
- High oxygen consumption
- Concentration of polyunsaturated fatty acids
- Exposure to sunlight
What antioxidants were used in AREDS 1?
- Vitamin C
- Vitamin E
- Betacrotene 15mg
- Zinc
- Copper
What changes were made in AREDS 2?
Removed Betacarotene and added lutein and zeaxanthin
What benefit was found in ARED2 compared to AREDS1?
20%
Did Omega 3 give any additional benefit?
No
What problems are there with betacarotene?
Increased risk of lung cancer in smokers in doses > 20mg/day
What size are small and intermediate drusen?
Small <63microns
Intermediate 63-125 microns
Where are type 2/ classic CNVM
Penetrating RPE into retina
What are the complications of wet AMD
- Serous retinal detachment
- Haem
- Progression of GA
- Subretinal fibrosis
- Charles Bonnet syndrome
- Low vision = depression, falls, fractures, loss of driving licence and lower qol
What is retinal angiomatous proliferation?
Subset of wet AMD but when proliferation occurs from retinal capillaries.
Starts intra-retinally and may go sub-retinal and then into choroidal
How do patients with RAP differ from traditional wet AMD patients?
Maybe be older and lesions are usually bilateral and juxtafoveal.
Does RAP respond to anti-VEGF?
Partially
What is ICPV?
Idiopathic choroidal polypoidal vasculopathy, a variant of wet AMD
How are ICPV patients different from traditional wet AMD patients?
Usually younger and asian
What other causes of CNVM are there? (5)
- Myopia
- Trauma
- Inflammation
- Angiod streaks
- Tumours
What other causes of fluid leaks are there? (2)
- Central serous chorioretinopathy
- Optic disc pits
Which inherited macula dystrophies can mimic wet AMD?
- Sorsby macula degeneration
- Adult vitelliform dystrophy
