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Age-Related Macular Degeneration (ARMD)

Topic updated on 11/26/16 9:19pm

Snapshot
  • A 65-year-old male presents with progressive left-eye central vision loss over the last few months. His peripheral vision is intact. The patient denies smoking and drinks a 2-3 alcoholic beverages during social gatherings. When looking at a specific region in a line grid, he reports a dark “spot” in the center, with bent lines. Dilated ophthalmic examination is shown.
Introduction
  • Degenerative disease involving the macula loss of central vision
    • peripheral and navigational vision is uninvolved
  • Classification
    • wet (neovascular, exudative)
      • pathogenesis involves choroidal neovascularization
        • secondary to vascular endothelial growth factor (VEGF)
      • disease progression usually occurs over months
    • dry (atrophic)
      • pathogenesis unclear
      • drusen deposition (early in disease), retinal atrophy, central retinal degeneration
      • disease progression usually occurs over decades
  • Epidemiology
    • mostly affects those > 50 years old
    • a leading cause of blindness
Presentation
  • Symptoms
    • wet-ARMD
      • acute visual distortion
      • central vision loss
        • secondary to fluid accumulation
      • usually affects one eye
      • metamorphopsia
        • can appear early in disease
    • dry-ARMD
      • gradual vision loss
      • metamorphopsia
Evaluation
  • Clinical diagnosis 
    • retinal examination
      • wet-ARMD
        • hemorrhage or fluid in subretina
        • neovascularization
          • macular grayish-green discoloration
      • dry-AMD
        • drusen deposition
        • areas of retinal atrophy (depigmentation)
        • retinal pigment epithelium motteling (pigmentation)
  • Fluorescein retinal angiography
  • Optical coherence tomography (OCT)
  • Amsler grid
    • line distortion seen on grid
Differential
  • Vascular tumors of the retina
    • e.g., von Hippel-Lindau disease
Treatment
  • wet-ARMD
    • VEGF inhibitors (e.g., bevacizuzmab)
    • photodynamic therapy
    • zinc and antioxidant vitamins
  • dry-ARMD
    • zinc and antioxidant vitamins
Prognosis, Prevention, and Complications
  • Prevention
    • certain vitamin supplements and dietary factors may reduce the risk of ARMD
  • Complications
    • blindness


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