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    Age Related Macular Degeneration

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    Rebecca Wong
    This document discusses age-related macular degeneration (ARMD), which is a leading cause of blindness in people over 50. It describes the basic pathology of ARMD, including damage to the retinal pigment epithelium and formation of drusen deposits. ARMD is divided into "dry" and "wet" forms, with the wet form causing more rapid vision loss. The document outlines how to assess patients for ARMD through history, vision testing, and retinal imaging. Treatments discussed include lifestyle changes and vitamin supplements for dry ARMD and anti-VEGF injections for wet ARMD.

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    Download as PDF, TXT or read online from Scribd

    Age Related Macular Degeneration

    Uploaded by

    Rebecca Wong
    151 views26 pages
    This document discusses age-related macular degeneration (ARMD), which is a leading cause of blindness in people over 50. It describes the basic pathology of ARMD, including damage to the retinal pigment epithelium and formation of drusen deposits. ARMD is divided into "dry" and "wet" forms, with the wet form causing more rapid vision loss. The document outlines how to assess patients for ARMD through history, vision testing, and retinal imaging. Treatments discussed include lifestyle changes and vitamin supplements for dry ARMD and anti-VEGF injections for wet ARMD.

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    Age Related Macular Degeneration

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    This document discusses age-related macular degeneration (ARMD), which is a leading cause of blindness in people over 50. It describes the basic pathology of ARMD, including damage to the retinal pigment epithelium and formation of drusen deposits. ARMD is divided into "dry" and "wet" forms, with the wet form causing more rapid vision loss. The document outlines how to assess patients for ARMD through history, vision testing, and retinal imaging. Treatments discussed include lifestyle changes and vitamin supplements for dry ARMD and anti-VEGF injections for wet ARMD.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    151 views26 pages

    Age Related Macular Degeneration

    Uploaded by

    Rebecca Wong
    This document discusses age-related macular degeneration (ARMD), which is a leading cause of blindness in people over 50. It describes the basic pathology of ARMD, including damage to the retinal pigment epithelium and formation of drusen deposits. ARMD is divided into "dry" and "wet" forms, with the wet form causing more rapid vision loss. The document outlines how to assess patients for ARMD through history, vision testing, and retinal imaging. Treatments discussed include lifestyle changes and vitamin supplements for dry ARMD and anti-VEGF injections for wet ARMD.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 26

    RCSI Royal College of Surgeons in Ireland Coliste Roga na Minle in irinn

    Age related macular


    degeneration
    Senior cycle 1
    2016-17

    Learning Outcomes
    At the end of this tutorial, you will be able to:
    Describe the basic epidemiology of ARMD as a major cause
    of blindness
    Explain the basic pathology that damages the retina in ARMD
    Assess a patient presenting with ARMD, including taking a
    relevant history and performing the appropriate examination
    and investigations
    Describe treatment regimens for ARMD and advise patients
    on recognised preventative measures

    The Retina

    LIGHT

    Retinal Transparency
    Required for normal function
    allows light through
    Unmyelinated axons
    Low density blood vessels
    Blood retinal barriers
    Loss of transparency
    Haemorrhage
    Oedema
    Visual loss

    The Normal Retina


    Optic disc
    Retinal blood vessels
    Macula
    Peripheral retina
    Fovea

    Retinal Disease
    Clinical assessment
    History
    VA
    Amsler grid
    Ophthalmoscopy
    Retinal imaging
    FFA
    OCT

    Age Related Macular Degeneration


    Leading cause of blindness > 50
    Risk Factors

    Age
    Caucasian
    Smoking
    Diet

    Symptoms
    Distortion of vision
    Central scotoma (blind spot)
    Reading difficulties

    Amsler grid

    http://www.nei.nih.gov/health/maculardegen/armd_facts.asp

    Sight loss in AMD

    http://www.nei.nih.gov/health/maculardegen/armd_facts.asp

    Age Related Macular Degeneration


    Divided into dry (atrophic) (90%) and wet (exudative)
    (10%)
    Wet ARMD presents with more rapid loss of vision and
    distorted vision over days compared with months for dry

    ARMD
    Wet ARMD is more damaging to vision

    Causes of Sight Loss in Ireland

    Impact of population growth and ageing

    225,000 people in Ireland who are blind or visually impaired


    Personal, social and economic impact
    Population growth
    2011
    (000)

    2021
    (000)

    2026
    (000)

    Total Population 4,738

    5,687

    6,068

    28.1%

    65-69

    173.5

    236.8

    267.5

    54.2%

    70-74

    130.8

    201.8

    224.8

    71.9%

    75-79

    101.7

    146.3

    183.7

    80.7%

    80-84

    70.3

    95.6

    123.6

    75.8%

    +85

    60.4

    94.3

    118.6

    96.3%

    Age Group

    % Change 2011/2026

    By 2020, 272,000 people will be blind or visually impaired based on


    estimates

    ARMD
    Pathology
    Retinal pigment epithelial (RPE) cell loss
    Drusen = deposits between RPE and photoreceptors
    Photoreceptor loss

    Dry ARMD
    Drusen
    Lipofuscin in RPE
    Pigmentary changes
    Mild visual impairment at this stage

    Dry ARMD

    Geographic atrophy
    - leads to greater vision loss
    - Develops slowly

    Dry ARMD

    Wet ARMD
    Choroidal neovascular membrane
    Haemorrhage
    Oedema
    Inflammation

    Distortion
    Central visual loss

    Wet ARMD

    Submacular haemorrhage
    Macular exudates and oedema
    - Indicate choroidal neovascular membrane

    Wet ARMD

    End-stage ARMD
    Geographical atrophy
    Scarring
    Irreversible loss of central
    vision

    End-stage wet ARMD

    Submacular fibrosis

    ARMD
    Investigations

    OCT
    3D imaging
    Retinal thickness
    Fluid
    Fluorescein Angiography
    Leakage
    hyperfluorescence

    Treatment of ARMD
    Early
    Lifestyle changes stop
    smoking
    Diet
    Exogenous antioxidants
    Vitamins C, E
    -Carotene
    Zinc
    Macular pigments
    Lutein
    Zeaxanthin

    Treatment of ARMD
    Wet ARMD
    Intra-vitreal anti-VEGF therapy
    Loading therapy x 3 months
    Maintenance therapy
    2/3 stabilise
    1/3 improve

    Treatment of ARMD
    Dry ARMD
    Low vision magnifying aids
    Social services
    Vitamin supplements unproven benefit

    Learning Outcomes
    At the end of this tutorial, you will be able to:
    Describe the basic epidemiology of ARMD as a major cause
    of blindness
    Explain the basic pathology that damages the retina in ARMD
    Assess a patient presenting with ARMD, including taking a
    relevant history and performing the appropriate examination
    and investigations
    Describe treatment regimens for ARMD and advise patients
    on recognised preventative measures

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