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Updated: Feb 13 2018

Age-Related Macular Degeneration (ARMD)

  • Snapshot
    • A 65-year-old male presents with progressive left-eye central vision loss over the last few months. His peripheral vision is intact. The patient denies smoking and drinks a 2-3 alcoholic beverages during social gatherings. When looking at a specific region in a line grid, he reports a dark “spot” in the center, with bent lines. Dilated ophthalmic examination is shown.
  • Introduction
    • Degenerative disease involving the maculaloss of central vision
      • peripheral and navigational vision is uninvolved
    • Classification
      • wet (neovascular, exudative)
        • pathogenesis involves choroidal neovascularization
          • secondary to vascular endothelial growth factor (VEGF)
        • disease progression usually occurs over months
      • dry (atrophic)
        • pathogenesis unclear
        • drusen deposition (early in disease), retinal atrophy, central retinal degeneration
        • disease progression usually occurs over decades
    • Epidemiology
      • mostly affects those > 50 years old
      • a leading cause of blindness
  • Presentation
    • Symptoms
      • wet-ARMD
        • acute visual distortion
        • central vision loss
          • secondary to fluid accumulation
        • usually affects one eye
        • metamorphopsia
          • can appear early in disease
      • dry-ARMD
        • gradual vision loss
        • metamorphopsia
  • Evaluation
    • Clinical diagnosis
      • retinal examination
        • wet-ARMD
          • hemorrhage or fluid in subretina
          • neovascularization
            • macular grayish-green discoloration
        • dry-AMD
          • drusen deposition
          • areas of retinal atrophy (depigmentation)
          • retinal pigment epithelium motteling (pigmentation)
    • Fluorescein retinal angiography
    • Optical coherence tomography (OCT)
    • Amsler grid
      • line distortion seen on grid
  • Differential
    • Vascular tumors of the retina
      • e.g., von Hippel-Lindau disease
  • Treatment
    • wet-ARMD
      • VEGF inhibitors (e.g., bevacizuzmab)
      • photodynamic therapy
      • zinc and antioxidant vitamins
    • dry-ARMD
      • zinc and antioxidant vitamins
  • Prognosis, Prevention, and Complications
    • Prevention
      • certain vitamin supplements and dietary factors may reduce the risk of ARMD
    • Complications
      • blindness
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