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 macula → loss of central vision peripheral and navigational vision is uninvolved Classification wet (neovascular, exudative) pathogenesis involves choroidal neovascularization login to view 1 more bullet 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 login to view 1 more bullet usually affects one eye metamorphopsia login to view 1 more bullet dry-ARMD gradual vision loss metamorphopsia Evaluation Clinical diagnosis retinal examination wet-ARMD login to view 3 more bullets dry-AMD login to view 3 more bullets 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