Age-related macular degeneration Definition Macular changes without obvious cause. Characterised by deposition of drusen (small colloid bodies) between retinal pigment epithelium (RPE) and the Bruch's membrane which lines the underlying choroid. Types Early and intermediate age-related macular degeneration (AMD) features drusen deposits with little or no visual symptoms. Can progress to late (aka advanced) AMD, which has 2 forms: Dry (aka atrophic, geographical atrophy): drusen in macula causing progressive atrophy of the RPE. Wet (aka neovascular, exudative): new vessels grow from choroid into retina and leak, causing scarring and possibly detachment. Less common than dry but cause of most visual loss. The term age-related maculopathy is sometimes synonymous with AMD, or refers to pre-clinical stages of disease. Epidemiology Main cause of blindness in UK. UK prevalence: 5% >60 years old, 10% >80.

1. Age-related macular
degeneration
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2. Definition
 Macular changes without obvious cause.
 Characterised by deposition of drusen (small colloid bodies) between
retinal pigment epithelium (RPE) and the Bruch's membrane which lines
the underlying choroid.
Types
Early and intermediate age-related macular degeneration
(AMD) features drusen deposits with little or no visual
symptoms. Can progress to late (aka advanced) AMD, which has
2 forms:

3. Types
 Dry (aka atrophic, geographical atrophy): drusen in macula
causing progressive atrophy of the RPE.
 Wet (aka neovascular, exudative): new vessels grow from
choroid into retina and leak, causing scarring and possibly
detachment. Less common than dry but cause of most visual
loss.
The term age-related maculopathy is sometimes synonymous
with AMD, or refers to pre-clinical stages of disease.

4. Epidemiology
 Main cause of blindness in UK.
 UK prevalence: 5% >60 years old,
10% >80.

5. Signs and symptoms

6. Can be asymptomatic.
Symptoms:
 Distorted vision: straight lines look wavy, micro/macropsia.
 Loss or blurring of central vision, with black/grey scotoma.
 In wet AMD, photopsia (flashes) or floaters.
 Difficulty driving, reading, recognising faces.
 Usually bilateral, but can be asymmetrical.
 Rapid symptom progression in wet AMD.
Signs:
 ↓Visual acuity.
 Fundoscopy: drusen, pigment changes, atrophy, haemorrhages,
detachment, scarring (thick yellow patch).

7. Risk factors

8. Risk factors
 Age
 Family history.
 Smoking
 Hypertension
 Obesity

9. Investigations
 Slit-lamp exam: clearer view of fundoscopy
findings, and can diagnose early and dry AMD.
 Optical coherence tomography (OCT) produces a
3D retinal image and can rule out (but not
confirm) wet AMD.
 Fluorescein angiography – a retinal angiogram
using IV dye – to confirm wet AMD diagnosis.

10. Management

11. Advice and support
 Stop smoking to slow progression.
 High-dose micronutrients – vitamin C, vitamin E, β-
carotene, and zinc – for intermediate or late dry
AMD.
 Ensure any refractive errors are corrected by
optician.
 Help with access to aids like large-print books.

12. Advice and support
 Encourage registration as sight impaired to aid access to
benefits. Certificate of Vision Impairment is provided by
ophthalmologist, and classified as severe/blind or
slight/partially-sited.
 Advise not to drive and contact DVLA. Usually not allowed to
drive if can't read number plate from 20 metres.
Specific treatment
No specific treatments for dry AMD.

13. Wet ARMD:
 VEGF (vascular endothelial growth factor) inhibitors
by intravitreal injection (4-8 weekly): ranibizumab,
aflibercept, or bevacizumab (the last being a
colorectal cancer drug not licensed for AMD, but
equally effective).
 Photodynamic therapy is an alternative but now
not commonly used.

14. Thank you
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