6. OCULAR PAST MEDICAL FAMILY PERSONAL
HISTORY HISTORY HISTORY AND
SOCIAL
HISTORY
2007-Cataract (+) HPN x 5 yrs (+) HPN Previous
extraction, OU metoprolol (-) DM smoker
No other (-) DM (-) Ca Non alcoholic
ocular disease beverage
drinker
housewife
8. OCULAR EXAMINATION
OD OS
Visual acuity 20/70-20/30 20/200- NI
IOP 10 10
Ocular adnexae E/N E/N
AC Deep and quiet Deep and quiet
Lens IOL in place IOL in place
EOM intact intact
pupils 3-2 mm 3-2 mm
(-) RAPD (-) RAPD
Color perception (+) RGB (-) blue
14. AGE- RELATED MACULAR
DEGENERATION
• Leading cause of IRREVERSIBLE vision loss in
the developed countries
• 4th common cause of vision loss in Phil
• Autosomal dominant disease affected by
nutritional and environmental factors
• bilateral
15. • I. Dry/ Non- exudative/Non-
neovascular AMD- 90%
• II. WET/Exudative/Neovascular-
10 %
16. CHANGES DURING AGING
REDUCED DENSITY AND DISTRIBUTION OF
PHOTORECEPTORS
INVOLUTIONAL CHANGES IN THE
CHORIOCAPILLARIES
28. MANAGEMENT
• NO definitive treatment
• DETERMINE PERSONS WHO WILL DEVELOP
ADVANCED ARMD
• Goal: prevent development of
neovascularization
29. Age- Related Eye Disease Study
• Vitamin A ( Beta Carotene)- 15 mg
• Vitamin C- 500 mg
• Vitamin E- 400 IU
• Zinc- 80 mg
• Copper- 2 mg
30. AREDS
Antioxidants plus Zinc alone Antioxidants alone
zinc
Reduced risk of
developing AMD by
25% 21% 17%
Reduced risk of
vision loss by
19% 11% 10%
31. Who will benefit from high- dose
antioxidants?
• Extensive intermediate drusen
• At least 1 large druse
• geographic atrophy
• Advanced AMD in one eye
32. LUTEIN
“Dietary lutein/zeaxanthin intake was inversely
associated with neovascular AMD”
-The Relationship of Dietary Carotenoid and Vitamin A, E, and C Intake With Age-Related Macular Degeneration
in a Case-Control StudyAREDS Report No. 22
• Age-Related Eye Disease Study Research Group*
• Arch Ophthalmol. 2007;125(9):1225-1232
33. “visual function is improved with lutein alone or
lutein together with other nutrients”
• Double-masked, placebo-controlled, randomized trial of lutein and antioxidant supplementation in the intervention of
atrophic age-related macular degeneration: the Veterans LAST study (Lutein Antioxidant Supplementation Trial).
• Richer S, Stiles W, Statkute L, Pulido J, Frankowski J, Rudy D, Pei K, Tsipursky M, Nyland J.
• Department of Veterans'Affairs, Medical Center Eye Clinic, North Chicago, Illinois 60064-3095, USA.
stuart.richer1@med.va.gov
34. PROPHYLACTIC LASER
PROPHYLACTIC TREATMENT OF AMD TRIAL (PTAMD):
̋ Patients treated wih prophylactic laser were more likely to have
a CNV event ( 21%) than were the observed patients at 18
months ( 14%) ̋
COMPLICATIONS OF AGE- RELATED MACULAR
DEGENERATION PREVENTION TRIAL ( CAPT)
Incidence of late AMD was 19.7% in treated eyes and 20.4 % in
untreated eyes, incidence of CNV was 13.3% for both groups
35. RHEOPHERESIS
• - An extracorporeal blood filtration procedure that
removes circulating macromolecules from the blood
MULTICENTER INVESTIGATION OF RHEOPHERESIS OF
AMD( MIRA-1)
‘No statistically significant benefit of rheopheresis over sham
treatment’
37. Laser Photocoagulation
MACULAR
PHOTOCOAGULATION
STUDY
• Treatment did not decrease
the chance of maintaining
good VA or vision within 1.5
lines of VA before the
treatment
38. Photodynamic therapy
TREATMENT OF AMD
WITH PHOTODYNAMIC
THERAPY
-‘59 % of PDT treated eyes
versus 31% (placebo)
avoided moderate vision
loss’
• Visudyne in Minimally
Classic Trial
• Vertoporfin in
Photodynamic Therapy
study
39. Anti- VEGF
• MARINA Study
ANCHOR STUDY
• 95% of Ranibizumab
-95% vs 64% of PDT
treated patients
treated patients
experienced visual
maintained/ improved
vision- 12 mos vs 62% of
improvement
-90% vstreated patients
sham 65.7 % after 24
mos
-41% of patients improved
3 lines after 24 mos
