AMD- Types, treatment and diagnosis and definition

1. MACULAR DEGENERATION
• Anil Adhikari
• Renaldine Florisca
• Zainabu Isa
• Wai Kin Siu

2. AGE-RELATED MACULAR
DEGENERATION
• Age-related macular degeneration (AMD)
is an eye disease that affects central vision.
Patient with AMD can’t see people or
things directly in front of them. This
common age-related eye problem occurs
in people over the age of 50. AMD affects
the macula, the back part of the retina that
controls central vision. People with AMD
aren’t completely blind. Their peripheral
vision (ability to see things off to the sides)
is fine.

3. CAUSES
AMD is a type of inherited eye disease. However, the
disease also develops in people with no family history
of the disease. AMD occurs when the macula at the
back of the eye starts to deteriorate for unknown
reasons.
• AMD is more likely to occur as you get older. Other
risk factors include:
• Family history of AMD.
• Being overweight.
• Smoking.
• High blood pressure (hypertension).
• A diet high in saturated fats.
• Being of European descent.

4. VISUAL
SYMPTOMS
The macula helps send images from
the eye’s optic nerve to the brain. If
you have a damaged macula, your
brain can’t understand or read the
images that your eyes see.
Many people with age-related
macular degeneration don’t have
symptoms until the disease
progresses. You may experience:
• Blurred (low) vision.
• Blank or dark spots in your field of
vision.
• The appearance of waves or
curves in straight lines.

5. TWO TYPES OF AMD
• Dry (atrophic): Up to 90% of people with macular
degeneration have the dry form. It develops when
tiny yellow protein deposits called drusen form
under the macula. The built-up deposits dry and
thin the macula. Vision loss with the dry form tends
to occur gradually. Most people don’t completely
lose central vision. Rarely, the dry form leads to the
wet form.

6. TWO TYPES OF AMD
• Wet (exudative): This condition occurs when
abnormal blood vessels develop under the retina
and macula. The blood vessels leak blood and fluid
(a condition called choroidal neovascularization, or
CNV). Because of fluid buildup, a bulge forms in
the macula. You may see dark spots in your center
of vision. About 15% of people with macular
degeneration have the wet form. This type is more
severe. It can quickly lead to total loss of central
vision.

7. DIAGNOSIS
• There are various ways to diagnose macular degeneration, but
the three most popular ones are as follows:
1. Amsler Grid Visual Field Test
2. Fundus fluorescein angiography (FFA)
3.Optical Coherence Tomography (OCT)
An Amsler grid is a simple and common home test used to monitor vision. This test is used to assess the macula, the
centre of the retina responsible for detailed central vision. The Amsler grid consists of evenly spaced horizontal and
vertical lines printed on white paper. A small dot is in the centre of the grid for fixation. While staring at the dot one eye
at a time, the patient looks for wavy lines and missing areas on the grid. Upon noticing any distortions or missing areas
on the grid’s surface, an appointment should be made immediately to discuss these changes with an eye care
professional.
1. Amsler Grid Visual Field Test

8. AMSLER GRID TEST
PROCEDURE
• Px will sit in a well-lit area and hold the
grid (12-14 inches) away from them in such a
way that they are in their most comfortable
position. Patients should keep their glasses if
they wear them. Then, with one eye closed,
px will look to the centre of the grid with an
open eye, observing the pattern of horizontal
and vertical lines in their peripheral vision.
Then do the same for the other eye as well.
Typically, a vision abnormality due to AMD
would cause some of the straight lines to
appear wavy or blurry or areas to appear
dark and even blank.

9. 2. Fundus Fluorescein Angiography
Photographs, which are typically px with macula degeneration,
will show a bleeding or NEOVASCULARIZATION underneath the
macula (WET FORM) and/or a yellowish white spot under the
retina (DRY FORM). This small yellowish white spot is called
DRUSEN.
A B C
A - N o r m a l
B - D r y A M D
C - We t A M D
This test will be performed
by inserting standard
dilation eye drops into the
px eyes. These make the
pupils dilate. The patient
will next be instructed to
rest their chin and forehead
against the camera's
supports so that their head
stays still throughout the
testing.
The doctor will then use the
camera to take many
pictures of the px inner eye.
Once the doctor has
completed the first batch of
pictures, he/she will give a
small injection into a vein
of the px arm. This injection
contains a dye called
fluorescein. The doctor will
then continue to take
pictures as the fluorescein
moves through the blood
vessels into the retina.

10. 3. OPTICAL COHERENCE
TOMOGRAPHY (OCT)
• An optical coherence tomography (OCT)
scan uses reflected light beams to create a
detailed image of the inside of the patient's
eye. This test is used to check for a wide
range of conditions that affect the retina and
macula, including macular degeneration. An
OCT scan is noninvasive and only takes about
5 or 10 minutes.

11. Treatments for Macular Degeneration
Dry AMD treatment
Right now, there is no way to treat the dry form of
AMD. However, people with lots of drusen or serious
vision loss might benefit from taking a certain
combination of nutritional supplements. A large study
(AREDS and the subsequent AREDS 2 study)
discovered that people with certain drusen may be
able to slow their dry AMD by taking these vitamins
and minerals daily.
•500 mg vitamin C
•400 IU vitamin E
•Lutein (10 mg)
•Zeaxanthin (2 mg)
•Zinc (80 mg)
•(2 mg) copper
However, not all forms will benefit from the AREDS
supplements, so it is always a good idea to follow the
doctor's recommendations. Smokers should not use
beta carotene as it raises the risk of lung cancer.
To help treat wet AMD, there are medications called anti-VEGF
drugs. Anti-VEGF treatment helps reduce the number of abnormal blood
vessels in the patient's retina. It also slows any leaking from blood vessels.
This medicine is delivered to the patient's eye through a very slender
needle.
Laser surgery may also be used to treat some types of wet AMD. In this
procedure, the eye surgeon shines a laser light beam on the abnormal
blood vessels. This process reduces the number of vessels and slows their
leakage.
Wet AMD treatment

12. THANK YOU