Potentially progressive maculopathy.
Sudden-onset of blurring or distortion of vision is often the presenting symptom.
Characterized by drusen formation, macular pigmentary changes, geographic atrophy, and neovascularization of the choriocapillaris with exudation.
Leading cause of adult blindness in industrialized nations.
Typically affects white people aged >55 years.
Diagnosis and treatment are highly specialized and involve consultation with a retinal specialist.
Age-related macular degeneration (AMD) is a potentially progressive maculopathy. It is characterized by distinct clinical stages including early and intermediate AMD with drusen 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 2 forms: geographic atrophy (or “atrophic” or “dry” AMD) and neovascular AMD (or “wet” or "exudative” AMD).
Subjects with small drusen (<63 micrometers), also termed drupelets, are considered to have normal aging changes. Subjects with medium-sized drusen (≥63 to <125 micrometers) in the absence of pigmentary changes are defined as having early AMD. Subjects with large drusen (≥125 micrometers) 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 aging changes up to 50% risk for intermediate AMD.
History and exam
Paul Bishop, PhD, FRCOphth
Manchester Royal Eye Hospital
Central Manchester University Hospitals NHS Foundation Trust
Professor of Ophthalmology & Matrix Biology
Centre for Hearing and Vision Research
University of Manchester
PB has undertaken research activities and received research grants (from charities and the Medical Research Council) that relate to basic mechanisms underpinning age-related macular degeneration. He is an inventor on a patent for a new treatment for age-related macular degeneration filed by the University of Manchester. He does not believe that any of these activities are competing interests with respect to the content of the monograph.
Dr Paul Bishop would like to gratefully acknowledge Dr Leon Charkoudian and Dr Joshua L. Dunaief, the previous contributors to this monograph. LC and JLD declare that they have no competing interests.
Sharon Fekrat, MD
Duke University Eye Center
SF declares that she has no competing interests.
Usha Chakravarthy, MBBS, FRCS, PhD
Professor of Ophthalmology and Vision Sciences
Centre for Vision Science
Queen's University Belfast
UC declares that she has no competing interests.
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