Post on 16-Apr-2017
AGE RELATED MACULAR
DEGENERATION
DEFINITION
Macular degeneration, often age-related macular degeneration (AMD or ARMD), is a medical condition that usually affects older adults and results in a loss of vision in the center of the visual field (the macula) because of damage to the retina.
CHARACTERISTIC FEATURES Age : above 50 yrs - senile macular
degeneration
bilateral
CLINICAL TYPES
Non Exudative ARMD- mild to moderate gradual loss of vision central shadowing
Exudative ARMD-
rapidly progressivemarked loss of vision
PATHOPHYSIOLOGY-DRUSENS-FA
Degree of hyperfluorescence depends on: Extent of overlying RPE atrophy (window
defect) Amount of staining Lipid content
RISK FACTORS Heredity Nutrition Smoking Hypertension Exposure to sunlight Hyperopia Blue eyes Cataract
NON EXUDATIVE ARMD
Dry or geograhic
Accounts for 90% ARMD
atrophy of the retinal pigment epithelial layer
vision loss through loss of photoreceptors (rods and cones) in the central part of the eye
LESIONS ON OPHTHALMOSCOPE Early : 1-Maular drusens-small to medium sized 2-Focal hyperpigmentation 3-Pale area of RPE atrophy
Intermediate : 1-drusens-large sized 2-sharply cirumscribed circular RPE atrophy
Advanced : 1-Enlarged atrophi areas 2- preexisting drusens disappear 3- visible larger choroidal vessels
Initial drusen and non-specific RPE changes
Late RPE (geographic) atrophy
EXUDATIVE ARMD
Wet or neovascular type
Accounts for 10%
due to abnormal blood vessel growth (choroidal neovascularization) in the choriocapillaris, through Bruch's membrane, ultimately leading to blood and protein leakage below the macula.
irreversible damage to the photoreceptors
and rapid vision loss if left untreated
LESIONS Pigment epithelial detachment (PED)
Choroidal neovascularization (CNV)
SIGNS OF PIGMENT EPITHELIAL DETACHMENT
Circumscribed, dome-shaped elevation
Sub-RPE fluid may be clear or turbid
SIGNS OF CHOROIDAL NEOVASULARISATION
Pinkish-yellow subretinal lesion with fluid
Subretinal blood or lipid
DIAGNOSIS
To see Amsler grid Snellen chart typial signs eluidated on slit-lamp
biomicroscopy Fundus flurescene angiography
Iodocyanine angiography Optical coherene tomography
FLUORESCEIN ANGIOGRAM
Hyperfluorescence from RPE window defect –Atrophic ARMD
ICG ANGIOGRAM OF PIGMENT EPITHELIAL DETACHMENT
Early, well-defined hypofluorescence
Later, thin surrounding hyperfluorescent ring No increase in size of lesion
MANAGEMENT-NON EXUDATIVE No effective treatment Measures tried- 1-dietary supplements & antioxidants 2-smoking cessation 3-Advice amsler grid regularly 4-low viosion aid
MANAGEMENT-EXUDATIVE Intraviteral anti-VEGF therapy Bevacizumab Ranibiuzumab Pegaptanib Photodynamic therapy-PDT Transpupillary thermotherapy Double frequeny YAG 532NM
photocoagulation Surgical treatment