Macular Degeneration

Age-related macular degeneration (AMD) is the most common cause of irreversible central vision loss in older patients. Dilated funduscopic findings are diagnostic; color photographs, fluorescein angiography, and optical coherence tomography assist in confirming the diagnosis and in directing treatment. Treatment is with dietary supplements, intravitreal injection of antivascular endothelial growth factor drugs, laser photocoagulation, photodynamic therapy, and low-vision devices.

• Risk factors include the following:
• Age
• Genetic variants (eg, abnormal complement factor H)
• Family history
• Smoking
• Cardiovascular disease
• Hypertension
• Obesity
• Sun exposure
• A diet low in omega-3 fatty acids and dark green leafy vegetables

Pathophysiology

Two different forms occur:

Dry (nonexudative or atrophic): All age-related macular degeneration (AMD) starts as the dry form. About 85% of people with AMD have only dry AMD.

Wet (exudative or neovascular): Wet AMD occurs in about 15% of people.

Normal Retina

• Age-Related Macular Degeneration (Dry, Intermediate)
• Age-Related Macular Degeneration (Dry, Advanced)

Although only 15% of patients with AMD have the wet form, 80 to 90% of the severe vision loss caused by AMD results from wet AMD.

Dry AMD causes changes of the retinal pigment epithelium, typically visible as dark pinpoint areas. The retinal pigment epithelium plays a critical role in keeping the cones and rods healthy and functioning well. Accumulation of waste products from the rods and cones can result in drusen, which appear as yellow spots. Areas of chorioretinal atrophy (referred to as geographic atrophy) occur in more advanced cases of dry AMD. There is no elevated macular scar (disciform scar), edema, hemorrhage, or exudation.

Wet AMD occurs when new abnormal blood vessels develop under the retina in a process called choroidal neovascularization (abnormal new vessel formation). Localized macular edema or hemorrhage may elevate an area of the macula or cause a localized retinal pigment epithelial detachment. Eventually, untreated neovascularization causes a disciform scar under the macula.

Conclusion

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Media Contact
Sarah Rose
Assistant Managing Editor
The Ophthalmologist: Clinical and Therapeutic Journal
Email: ophthalmologist@eclinicalsci.com