Opthamology - Age Related Macular Degeneration

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Age-Related Maculare Degeneration (AMD): Definition

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Acquired diseas of the outer retina (RPE-choriocapillaris) resulting in central vision loss due to atrophy of the neurosensory retina and/or pathologic choroidal neovascularization

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Age-Related Maculare Degeneration (AMD): Epidemiology

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Leading cause of vision loss in Canadians >65

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Age-Related Maculare Degeneration (AMD): Anatomy

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RPE
Bruch's Membrane
Choroid

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Age-Related Maculare Degeneration (AMD): Types

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Dry AMD: 90% of cases, good vision
Wet AMD = advanced AMD = Central GA (central vision loss) - 10% of cases

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Dry AMD: Clinical Presentation

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Symptoms: modest central visual blur/distortion
Signs: Drusen, pigmenary abnormalitis, geographic atrophy, serous pigment epithelial detachment

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Wet AMD: Symptoms

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central scotoma, progressive central and paracentral vision blurring (metamorphopsia), loss of visual acuity, altered colour vision

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Wet AMD: Signs

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choroidal neovascularizaton, subretinal hemorrhage/fluid/fibrosis

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AMD Scoring

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Large Drusen = 1pt
Pigmentary Abnormalitis=1pt
Score is out of 4 (2 per eye)
Predicts progression to wet AMD

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AMD: Pathogenesis

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1)Accumulation of metabolic byproducts (drusen) between RPE and Bruch's membrane
2)Thickening of Bruch's membrane causing disruption of metabolic exchange
3) Photoreceptor dysfunction and hypoxia induced VEGF production

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AMD: Management Strategies

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Primary Prevention
Secondary Prevention
Treatment of Wet AMD

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AMD: Risk Factors

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Non-modifiable: old age, family history, white race, female
Modifiable: smoking, diet, (UV exposure, Cataract Surgery)

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AMD: Primary Prevention

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Smoking Cessation
Diet high in anti-oxidants, omega 3 fatty acids

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AMD: Secondary Prevention (prevent dry transition to wet AMD)

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Opthalmic/optometric screening (for everyone)
Vitalux antioxidant vitamin (only at risk patients!)

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Treatment of Wet AMD

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Focal laser photocoagulation (outdated)
Photodynamic Therapy (not much improvement)
Anti-VEGF therapies (work, but need to keep giving - not curative)

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Wet AMD: Anti-VEGF injection

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pegaptanib (Macugen)- expensive and not that effective
bevacizumab (Avastin) - less expensive
ranibizumab (Lucentis) - most expensive but best result (some reversal of vision loss)

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Anti-VEGF intravitreal injection complications

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Endopthalmitis, retinal detachment,traumatic cataract, hemorrhage