633 - 7 Amd Part 1 Dx De

Front 1

AMD is the most common cause of vision loss in the elderly, in the world? in the developed world? or in developing countries?

Back 1

in the developed world

Front 2

name three causes of AMD. (on a cellular level)

Back 2

oxidative stress
inflammation
metabolic end product deposition

Front 3

what are the four layers that AMD primarily affects

Back 3

RPE, Bruchs membrane, choriocapillaris and the photoreceptors

Front 4

in general what area of the retina is destroyed by AMD. hint: periphery? posterior pole?.......

Back 4

Macula

Front 5

true or false peripheral vision is usually spared with AMD

Back 5

true

Front 6

AMD is the number 1 cause of blindness in the US in what age group? and number 2 in what age group?

Back 6

over 60 = 1
45 to 64 =2

Front 7

name 5 non modifiable risk factors for AMD

Back 7

age, gender, race, ocular pigmentation, and heredity

Front 8

what race as the highest risk of AMD

Back 8

caucasian>African Americans and there is an exponential increase in latinos with age

Front 9

what gender has a higher risk of developing AMD

Back 9

females

Front 10

what has a higher risk of AMD light ocular pigmentation or heavy?

Back 10

lighter

Front 11

name some modifiable risk factors for AMD

Back 11

obesity, HTN, cardio dz, macula pigment ocular density MPOD,

Front 12

how many mm in diameter is the foveal avascular zone

Back 12

.5 to .6mm

Front 13

what does the foveal avascular zone gets its nutrition from

Back 13

the choriocapillaris

Front 14

what prevents fluid seepage from the choriocapillaris to the retina

Back 14

the retinal pigment epithelium

Front 15

what is the general presentation of the RPE with AMD? pick - hyperplasia/hypertrophy or hypoplasia/hypotrophy

Back 15

hyperplasia hypertrophy

Front 16

what are we trying to prevent with the treatment of AMD. Know this for the test

Back 16

trying to prevent the CNV

Front 17

what are three general clinical presentation pearls with AMD

Back 17

drusen/lipofusin
RPE hyperplasia or hypertrophy
pigment epithelial detachment

Front 18

what are the three stages of AMD

Back 18

early, intermediate and advanced

Front 19

what are the two catagories of AMD within the advanced stage

Back 19

CNV 80% and geographic atrophy 20%

Front 20

true or false many patients have early AMD with no progression to late AMD

Back 20

true there is only a 1 to 18% chance of progressing from early to late AMD over 5 years

Front 21

during a FA areas of hypopigmentation in a pt with AMD will hyperflouresce or hypoflouresce

Back 21

hyperflourescence in areas of hypopigmentation

Front 22

for a pt with AMD that has pigment clumping, will you see hypo or hyperflourescence in these areas

Back 22

hypoglourescence

Front 23

true or false lipofuscin is only found in the eye

Back 23

false it is found in other body tissues

Front 24

Lipofuscin is found in/damages what layer of the retina? and is a risk factor for what dz

Back 24

found in/damages the RPE leading to RPE atrophy and drusen, and is a risk factor for AMD

Front 25

Drisen are extracellular deposits that lie b/t what layers

Back 25

b/t the RPE basement membrane and the inner collagenous zone of Bruch's membrane

Front 26

Drusen is unilateral or bilateral and symmetrical or asymetrical

Back 26

often bilateral and symmetrical

Front 27

is drusen only associated with AMD

Back 27

no it is also associated with retinal pathology, bruch's membrane dz, choriocapillaris dz, choroidal dz and RPE dz. but if it present then there is over an 80% chance of developing macular degeneration

Front 28

name the 5 types/classifications of drusen

Back 28

small hard
large soft
familial
calcific
drusenoid
you can also have a mixed variety

Front 29

small hard drusen are associated with a focal dysfunction of what retinal layer

Back 29

RPE

Front 30

describe the appearance of small hard drusen

Back 30

small <63µm round discrete, yellow dep deposits with well defined borders

Front 31

small hard drusen are found b/t what layers

Back 31

basemennt membrane of RPE and the inner collagenous layer of Bruchs

Front 32

hard drusen can break down to soft or soft can break down into hard

Back 32

hard can break down into soft

Front 33

describe the appearance of large soft drusen

Back 33

>63 um and fluffier than hard drusen, pale yellow, dome shaped with indistinct boarders,

Front 34

large soft drusen may appear identical to ___________(think of the layers it is b/t)

Back 34

RPE detachments

Front 35

soft drusen is associated with

Back 35

DIFFUSE RPE dysfunction (where as the hard drusen is a focal dysfunction)

Front 36

large soft drusen are found b/t what layers

Back 36

basemennt membrane of RPE and the inner collagenous layer of Bruchs

Front 37

what form of drusen can coalesce and create a retinal pigment epithelial detachment

Back 37

large soft drusen

Front 38

out of all of the types of drusen types what has the poorest prognosis of them all

Back 38

large soft drusen

Front 39

the presence of soft or hard drusen is sufficient to make the AMD diagnosis?

Back 39

soft

Front 40

the presence of soft drusen increases the risk for developing what three things

Back 40

RPE abnormalities
geographic atrophy
CNV

Front 41

will soft drusen hyper or hpyogluoresce early/late

Back 41

soft will hyperfluouresce early and then most likely stain late but may fade out

Front 42

what appears to influence the amount of hyperfluoresce in soft drusen

Back 42

the amount of RPE pigment overlying the drusen and the amount of lipid content in the drusen

Front 43

familial drusen is also known as?

Back 43

dominant drusen (it is autosomal dominant)

Front 44

familial drusen shows what type of genetic pattern from generation to generation

Back 44

autosomal dominant pattern (hence AKA dominant drusen)

Front 45

what age does familial drusen show up

Back 45

20-30's

Front 46

familial drusen is bilateral/ unilateral, symmetrical/asymmetrical, deep/superficial

Back 46

bilateral,symmetrical, and deep

Front 47

in general define what calcific drusen are

Back 47

long standing drusen that have aged and calcified leaving multifocal patches of atrophy and calcification deposits

Front 48

how does the appearance change when drusen is calcified

Back 48

it glistens secondary to calcification

Front 49

are there any differences b/t a serous PED and soft drusen formation? if so what are they

Back 49

no they is no practical difference b/t them

Front 50

you spot an area that appears raised and has sharply demarcated boarders. there also appears to be soft drusen associated with it. what could this be

Back 50

PED

Front 51

if you have a PED and and overlying sensory RD present this could indicate what

Back 51

a possible CNV

Front 52

a PED can remain stable for years but if it callapses it can cause what

Back 52

RPE or geographic atrophy

Front 53

a PED in an older pt has what kind of chance of developing CNV

Back 53

1/3 to 1/2 with the larger the PED the better the chance

Front 54

if you have soft drusen can you classify AMD as wet

Back 54

no it is only wet if there is neo

Front 55

what is more common wet or dry AMD

Back 55

dry (hard or soft)

Front 56

what percent of dry AMD progress to wet

Back 56

10 to 20%

Front 57

to have wet exudative AMD you must have what

Back 57

neo

Front 58

what causes the most accounts of blindness wet or dry

Back 58

wet causes 75% of legal blindness from AMD

Front 59

what results from slowly progressive atrophy of the RPE and photoreceptors

Back 59

non exudative AMD

Front 60

true or false you can have CNV with non exudative AMD

Back 60

false CNV is absent

Front 61

in non exudative AMD is the vision loss more noticeable during near or far tasks

Back 61

near

Front 62

what are some subjective complaints of nonexudative AMD

Back 62

maybe none, or gradual mild to mderate vision impairment that is more noticeable at near, may describe visual fluctuations or changes with night vision

Front 63

what types of RPE alterations are there with nonexudative AMD

Back 63

areas of depigmentation
areas of hyperpigmentation

Front 64

what areas of vision are usually spared with nonexudative AMD

Back 64

foveal is initially spared but eventually becomes involved and the periphery is also usually spared

Front 65

a person with several small or just a few medium sized drusen with no vision loss is classified as what stage of nonexudative AMD

Back 65

early stage

Front 66

a person with many medium sized drusen or on or more large , soft drusen with blurred vision or blind spot, metamorphopsia, and or decreased contrast sensitivity is classified as what stage of nonexudative AMD

Back 66

intermediate

Front 67

a person that has had a breakdown of photoreceptors and is relying on peripheral vision is in what stage of AMD

Back 67

advanced

Front 68

what is the best way to determine if AMD is exudative or non

Back 68

FA

Front 69

what type of antioxidants help fight free radicals (what vit's.)

Back 69

vit E, vit C and beta carotene

Front 70

smokers should not take what ingredient that was part ARED I formula

Back 70

beta carotene

Front 71

macular pigments are composed of what

Back 71

lutein and zeaxanthin

Front 72

true or false carotinoids are antioxidant compounds

Back 72

true

Front 73

what has a higher concentration in the center of the macula lutein or zeaxanthin

Back 73

zeaxanthin over lutein 2:1

Front 74

What has a higher concentration in the periphery of the macula lutein or zeaxanthin

Back 74

lutein over zeaxanthin 2:1

Front 75

the POLA study showed what

Back 75

a pt with high plasma levels of zeaaxanthin had a 93% reduction in AMD and a 77% reduction in nuclear cataracts

Front 76

true or false the AREDs 2 study is trying to show the effects of supplements on cataracts as well as vision loss

Back 76

true

Front 77

what is a supplement that AREDS 2 is trying to see the effects of eliminating it from AREDS 1

Back 77

beta carotene

Front 78

what are some things that you can educate your pt on to help reduce the risk on AMD

Back 78

HTN control, exercise, antioxidant supplementation, balanced diet with green leafy vegies, and sun protection

Front 79

what effect does omega 3 tend to have on the blood

Back 79

tends to thin the blood so be careful when prescibing to a pt that is already on blood thinners

Front 80

true or false there are actually support groups for macular degeneration

Back 80

true, www.macd.net
depression is common so may be helpful

Front 81

examples of things that provide us with vit E

Back 81

whole grains, nuts, wheat germ, oils, blueberries and beans

Front 82

examples of things that supply us with vit C

Back 82

oranges, grapefruit, melon, and broccoli

Front 83

examples of things that supply us wiht zinc

Back 83

beef, chicken, pork, lamb, sole, sesame seeds, beans and dairy producs

Front 84

carotenoids come from what

Back 84

fruits and veggies

Front 85

if a pt has minimal RPE changes with AMD when should you see them again

Back 85

1 year

Front 86

as you see that the RPE disruption is worsening in an AMD pt how often should you have them back

Back 86

every 6 months

Front 87

an AMD pt with high risk confluent drusen and or pigmentary degeneration should be seen how often

Back 87

every 4-6 months

Front 88

what are you looking for on a follow up exam on an AMD pt

Back 88

neo