Age-related macular degeneration

Last reviewed: 1 Nov 2022
Last updated: 30 Sep 2022

Summary

Definition

History and exam

Key diagnostic factors

  • sudden-onset blurring or distortion of vision
  • drusen
  • macular pigmentary changes
  • geographic atrophy
  • choroidal neovascularization
More key diagnostic factors

Other diagnostic factors

  • progressive loss of vision in one or both eyes
  • fibrovascular pigment epithelial detachment (neovascular AMD)
  • fibrovascular scar formation
  • reticular pseudodrusen
Other diagnostic factors

Risk factors

  • increasing age
  • smoking
  • family history of disease
  • previous cataract surgery
More risk factors

Diagnostic investigations

1st investigations to order

  • Amsler grid
  • optical coherence tomography
  • optical coherence tomography angiography
More 1st investigations to order

Investigations to consider

  • fluorescein angiography
  • indocyanine green angiography
  • autofluorescence imaging
More investigations to consider

Emerging tests

  • genotyping

Treatment algorithm

ACUTE

early stage (AREDS 1 and 2)

intermediate-stage (AREDS 3)

advanced-stage atrophic (dry) (AREDS 4)

advanced-stage exudative (wet) (AREDS 4)

Contributors

Authors

Sajjad Mahmood, MA, MB BCHIR, FRCOphth

Consultant Ophthalmologist and Medical Retina Specialist

Honorary Clinical Lecturer

Division of Pharmacy and Optometry

Faculty of Biology, Medicine, and Health

University of Manchester

Manchester

UK

Disclosures

SM has done consultancy work and received honoraria for lecturing and travel from Bayer Pharmaceuticals and Novartis. He has also been a principal investigator for clinical trials on behalf of Bayer, Novartis, and Roche.

Acknowledgements

Mr Sajjad Mahmood would like to gratefully acknowledge Dr Leon Charkoudian, Dr Joshua L. Dunaief, and Professor Paul Bishop, the previous contributors to this topic.

Disclosures

LC and JLD declare that they have no competing interests. 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 topic.

Peer reviewers

Sharon Fekrat, MD

Associate Professor

Vitreoretinal Surgery

Duke University Eye Center

Durham

NC

Disclosures

SF declares that she has no competing interests.

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