Age-related macular degeneration is a potentially progressive maculopathy.
Characterised by drusen formation, macular pigmentary changes, geographic atrophy, and neovascularisation of the choriocapillaris with exudation.
Sudden-onset of blurring or distortion of vision is often the presenting symptom in the neovascular form.
Leading cause of adult blindness in industrialised nations.
Typically affects people aged >55 years.
Diagnosis and treatment are highly specialised and involve consultation with a retinal specialist.
Age-related macular degeneration (AMD) is a potentially progressive maculopathy. It is characterised by distinct clinical stages including early and intermediate AMD with drusen (yellow deposits under the retina made up of lipids and proteins) and macular pigmentary changes, usually associated with normal or near-normal vision; and late AMD, which is associated with a decrease or loss of central vision. Late (or advanced) AMD has two forms: geographic atrophy (or 'atrophic' or 'dry' AMD) and neovascular AMD (or 'wet' or 'exudative' AMD). Geographic atrophy is a chronic progressive degeneration of the macula; degeneration commences at the level of the retinal pigment epithelium, which is lost in the late stages with associated thinning and degeneration of the neurosensory retina. Choroidal neovascularisation refers to the abnormal growth of blood vessels from the vascular layer of the eye (choroid) to the neurosensory retina.
People with small drusen (<63 micrometres), also termed drupelets, are considered to have normal ageing changes. People with medium-sized drusen (≥63 to <125 micrometres) in the absence of pigmentary changes are defined as having early AMD. People with large drusen (≥125 micrometres) or pigmentary abnormalities and at least medium-sized drusen are defined as having intermediate AMD.
Five-year risks of progressing to late AMD are estimated to increase from 0.5% for normal ageing changes up to 50% risk for intermediate AMD.
History and exam
Key diagnostic factors
- presence of risk factors
- sudden-onset blurring or distortion of vision
- macular pigmentary changes
- geographic atrophy
- choroidal neovascularisation
Other diagnostic factors
- progressive loss of vision in one or both eyes
- fibrovascular pigment epithelial detachment (neovascular AMD)
- fibrovascular scar formation
- reticular pseudodrusen
- increasing age
- family history of disease
- previous cataract surgery
1st investigations to order
- Amsler grid
- optical coherence tomography
- optical coherence tomography angiography
Investigations to consider
- fluorescein angiography
- indocyanine green angiography
- autofluorescence imaging
early stage (AREDS 1 and 2)
intermediate-stage (AREDS 3)
advanced-stage atrophic (dry) (AREDS 4)
advanced-stage exudative (wet) (AREDS 4)
- Idiopathic polypoidal choroidal vasculopathy
- Basal laminar drusen
- Myopic degeneration
- Preferred practice pattern: comprehensive adult medical eye evaluation
- Preferred practice pattern: age-related macular degeneration
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