age related macular degeneration presentation 1

7/28/2019 Age Related Macular Degeneration Presentation 1

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Age-related Macular

Degenerationllddmd-gcm10



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Older age group Prevalence increases past the age of 55

Gradually progressive simultaneous or suddensequential deterioration of central vision in both eyes.

Distortion or abnormal size of images.

No pain or redness.

Macular abnormalities seen by ophthalmoscopy.



Irreversible central visual loss Age-dependent alterations of the sensory retina,

retinal pigment epithelium, choriocapillaris complexin the central retina (macula)

Divided into exudative or wet and nonexudative ordry

Other associated factors are race (usually white), sex(slight female predominance), family history, a history

of cigarette smoking, nutrition, scleral rigidity, photicexposure, hypertension



Drusen

Pigmentary alterations

Exudative changes Hemorrhage

Hard exudates

Subretinal & subretinal pigment epithelium & intraretinalfluid

Atrophy Incipient

Geographic



Drusen

• Character for age-relatedmaculopathy

• Hard drusen:ophthalmoscopically discrete

yellow deposits

• Soft drusen: larger, paler, andless distinct.

Large, confluent soft drusen areparticularly associated withexudative age-related maculardegeneration.



Clinical Findings Exudative Degeneration / WET EXUDATIVE

choroidal new vessels grow between the retinal pigmentepithelium and Bruch's membrane, leading to accumulation

of serous fluid, hemorrhage, and fibrosis onset of visual loss is more rapid and more severe in exudative

degeneration than in atrophic degeneration

accounts for about 90% of all cases of legal blindness due toage-related macular degeneration



Clinical Findings Atrophic Degeneration / DRY NONEXUDATIVE

characterized by gradually progressive bilateral visual loss of moderate severity due to atrophy and degeneration of the

outer retina and retinal pigment epithelium



Symptoms Visual Blurring

Central Scotomas

Metamorphosia Visual distortion

Micropsia – images may appear smaller

Macropsia – images may appear larger



Antioxidant Supplementation

Lifestyle and Dietary Modifications

Intravitreal Angiogenic Therapy

Ranibizumab and Bevacizumab Ocular Photodynamic Therapy and Argon-Laser

Photocoagulation Therapy

Vitreoretinal Surgery



Combination Therapy

Intravitreal injection of the corticosteroid triamcinoloneacetonide (usually 4 mg) has been combined with

photodynamic therapy

Genetic Approaches

Adenoviral vector-mediated intravitreal gene transfer of pigment-epithelium–derived factor, an antiangiogeniccytokine, appears to help arrest the growth of choroidalneovascularization in humans



Intraocular Devices

Implantable miniature telescopes

Surgical implantation of optic-nerve, cortical,subretinal, and epiretinal electrically stimulated devices

age related macular degeneration presentation 1

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