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 a first degree relative with AMD how much more likely are you get AMD?

Answer 4

4X

Question 5

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

Answer 5

5X

Question 6

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

Answer 6

1.5%

Question 7

What are the indications for urgent referral or wet AMD?

Answer 7

Recent onset:

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

V/a better than 6/60

And/Or Haem Fluid on OCT Exudates

Question 8

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

Answer 8

5-9 years

Question 9

What % of dry patients will develop wet?

Answer 9

10-15%

Question 10

What is the differential diagnosis in dry AMD?

Answer 10

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

Question 11

What are the clinical features of dominant drusen?

Answer 11

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 12

Why is the retina so prone to oxidative stress?

Answer 12

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

Question 13

What antioxidants were used in AREDS 1?

Answer 13

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

Question 14

What changes were made in AREDS 2?

Answer 14

Removed Betacarotene and added lutein and zeaxanthin

Question 15

What benefit was found in ARED2 compared to AREDS1?

Answer 15

20%

Question 16

Did Omega 3 give any additional benefit?

Answer 16

No

Question 17

What problems are there with betacarotene?

Answer 17

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

Question 18

What size are small and intermediate drusen?

Answer 18

Small <63microns

Intermediate 63-125 microns

Question 19

Where are type 2/ classic CNVM

Answer 19

Penetrating RPE into retina

Question 20

What are the complications of wet AMD

Answer 20

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 21

What is retinal angiomatous proliferation?

Answer 21

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

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

Question 22

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

Answer 22

Maybe be older and lesions are usually bilateral and juxtafoveal.

Question 23

Does RAP respond to anti-VEGF?

Answer 23

Partially

Question 24

What is ICPV?

Answer 24

Idiopathic choroidal polypoidal vasculopathy, a variant of wet AMD

Question 25

How are ICPV patients different from traditional wet AMD patients?

Answer 25

Usually younger and asian

Question 26

What other causes of CNVM are there? (5)

Answer 26

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

Question 27

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

Answer 27

• Central serous chorioretinopathy
• Optic disc pits

Question 28

Which inherited macula dystrophies can mimic wet AMD?

Answer 28

• Sorsby macula degeneration
• Adult vitelliform dystrophy