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Macular degeneration (incidence (dry (90% of AMD), associated with incr…
Macular degeneration
incidence
dry
90% of AMD
associated with incr age
leading cause of irreversible visual loss
age-related macular changes in >10% 65-74y and 25% >74y
clinical
signs
drusen
atrophic pallor of retina
reactive hyperpigmentation of retina
choroidal neovascular membrane (wet)
disc-like haemorrahge
drusen
RPE atrophy/hyperplasia at centre
exudate/haemorrhage at periphery
symptoms
gradual progressive loss of central vision
difficulty reading and recognising distant objects
profound central visual loss
distortion of straight lines
consider co-existence of cataract and glaucoma
degeneration of the macula associated with age
wet
dry
pathophysiology
wet
choroidal neovascular membrane
growth under and into retina causes sudden visual deterioration and distortion
dry
defined by presence of drusen
atrophy of RPE cells
degenerative change in photoreceptor outer segments
gradual visual loss
ancillary
fundus fluorescin angiography (for Choroidal NeoVascular Membrane CNVM)
Optical Coherence Tomography
prognosis
dry
slowly progressive
wet
75% experience marked deterioration in vision over 3 years
complications
disease
blindness
depression
falls
treatment
aetiology
?
diagnosis
fundus examination
Treatment
medical
antioxidant vitamn and mineral combination
photodynamic therapy (laser)
WET ONLY
avastin
WET ONLY
refraction correction