2. Introduction
• Disease of the macular
– The macula is responsible for the fine central
vision in the eye that is needed for driving a
car, reading fine print, recognising faces, etc.
– Loss of central vision
• Most common cause of irreversible
visual loss in the western world in
individuals over the age of 50yrs
8. Prevalence
• Most common cause of irreversible visual
loss in the western world in individuals over
50 years
• 65-75yrs - 11% some central vision loss
• >75yrs - 30%
• Two types
– Dry (atrophic) most common 85-90%
– Wet (exudative or neovascular) 10-15%
12. Risk factors
■ Age
■ Family history. ARMD is, at least in part, an inherited disease.
Relative with ARMD then life time risk increases from 12% to 50%
■ Smoking. Current smokers have a 2–3-fold increased risk of AMD
with vision loss, compared with people that have never smoked.
■ Hypertension. There is an association between hypertension and
wet ARMD.
■ Race. ARMD is more common in Caucasians.
■ Female gender. Wet ARMD is more common in women.
13. Risk factors
■ Light exposure.
Excessive light exposure can damage the retina, but it is difficult to
quantify.
■ Diet poor in antioxidants.
A high intake of fats may increase the risk of advanced ARMD.
On the other hand a diet rich in fish and antioxidant nutrients has
been shown to lower the risk of ARMD.
In the Beaver Dam Eye Study, high dietary intake of carotenoids,
vitamin E and zinc was associated with a lower risk of ARMD.
• Carotenoids are red and yellow pigments found in plants, and include
zeaxanthin,lutein and beta-carotene.
18. Dry ARMD
• Presentation
– Most common, slowly progressive
– Gradual decrease in vision
– Often asymmetrical
19. Dry ARMD
• Signs
– Drusen
– Hyperpigmentation(RPE) or
atrophy(photoreceptors)
– Enlagement of these areas with visualization of
the choroidal vessels
21. Dry ARMD
• Slow progressive
atrophy of the
photoreceptors, retinal
pigment epithelium
and choriocapillaris
22. Wet ARMD
• Less common but devestating
• Caused by choroidal neovascularization
from the choriocapillaris, which break
through defects in Bruch’s membrane.
• May form a membrane under the RPE or
retina.
• Eventually leads to scaring
47. PDT
• PDT (photodynamic
therapy)
– Verteporfin
– Light activated
compound that targets
the neovascularization
– But does not damage
the retina
– Some stability and
some improvement of
vision
59. VEGF inhibitors
• Unfortunatly most patients require these
infections on an ongoing basis
• Future
– Implants
– VEGF trap
– Gene therapy
60. Prevention
• AREDS study
– Patients at high risk benefited from taking
supplements with a specific formulation of
vitamins and antioxidants
– Vit C, E and Zinc
– Beta carotene, Lutine, Zeaxanthine
– Ocuvite and ocuvite with lutine
65. Burden of illness
• Vision loss can devastate lives.
■ Visual impairment is associated with declining physical function and
depression
■ Vision loss increases the risk of co-morbid conditions and increases
mortality
■ Clinicians may underestimate the impact of vision loss on patient’s
functioning and well-being.
68. Conclusion
• ARMD is the leading cause of blindness in the
over 50s in the developed world
• There are essentially two main types of ARMD –
dry and wet
• Drusen, pigment and atrophy are features of early
and dry ARMD
• Neovascularization is a feature of wet ARMD
69. Conclusion
• Vision loss progresses slowly in dry ARMD, but
more aggressively in wet ARMD, which accounts
for 90% of severe vision loss in ARMD
• VEGF is the main factor promoting angiogenesis
• VEGF promotes increased vessel permeability,
endothelial cell proliferation and inflammation
• VEGF is found in high consentrations in eyes with
wet ARMD
70. Conclusion
• Symptoms of ARMD include metamorphopsia,
scotoma, loss of contrast sensitivity, and loss of
visual acuity.
• The amsler grid is a useful screening tool for
macular function.
• Fundus examination is key to diagnosis.
71. Conclusion
• OCT provides cross sectional images of the retina,
very valuable in monitoring treatment.
• Loss of vision translates into loss of function, loss
of independence, depression and susceptibility to
falls and accidents.
• New treatments with VEGF inhibitors can
stabalize the retina and improve vision.
This is the most important risk factor after age and family history. Since we can’t change our age or our family, smoking is the most important modifiable risk factor for AMD.
Different sizes and types of drusen that have different risks
Vision severly impaired if the fovea involved FA: early hyperfluoresence due to unmasking of the choroidal vessels OCT: atrophy
Less common but devastatingCharacterized by neovascularization and eventually scaring
Haemmorrhage exudation and eventual scaring
Uses laser to make a cross sectional picture of the retina
Almost like a hitiological cross section
Up until recently very little and mostly to try and stop usually no improvement
Cold laser
Retinectomy Poor results and high recurrence rate
Early detection and treatment Amsler Education reduced chance by 20% of getting severe visual loss in pts with one eye ARMD
Mostly magnification
Computer have large print Kindel books Audio books
Compares pts with ARMD to normal pts and how they cope with simple activities of daily living
