AGE - RELATED MACULAR DEGENERATION

DR. SASKIA N MOKOGINTA,SpM

AGE-RELATED MACULAR DEGENERATION (AMD) : USA : THE LEADING CAUSE OF SEVERE CENTRAL VISUAL ACUITY LOSS IN PEOPLE OVER 50 YEARS OF AGE. PREVALENCE : 85%-90% NONNEOVASCULAR AMD 10%- 15% NEOVASCULAR AMD

AMD DEFINED AS DEGENERATIVE ABNORMALITY IN THE MACULA AND DEMONSTRATE THE NONNEOVASCULAR OR NEOVASCULAR ABNORMALITIES.

ETIOLOGY

THE ETIOLOGY REMAINS POORLY UNDERSTOOD DEPITE THE DISEASES PREVALENCE AND GENETICS FACTOR. NORMAL AGING RESULTS IN CHANGES IN THE MACULA. AFFECTED THE OUTER RETINA : RPE ( RETINAL PIGMENT EPITHELIUM) BRUCHS MEMBRANE CHORIOCAPILLARIS.

CLASSIFICATION
NONNEOVASCULAR / DRY AMD NEOVASCULAR/WET AMD

POPULATION-BASED STUDIES HAVE SHOWN MOST AMDS PATIENTS HAVE ONLY NONNEOVASCULAR ABNORMALITY

PATHOGENESIS

DEGENERATION PROCESS OF THE RETINA : - DRUSEN : SMALL, ROUND , YELLOW LESIONS AT RPE WITHIN MACULA. THICKENING OF THE INNER ASPECT OF BRUCHS MEMBRANE

PATHOGENESIS
- FOCAL HYPERPIGMENTATION :

MIGRATING OF PIGMENT CELL TO PHOTORECEPTOR LEVEL. - ATROPHY OF RPE CELLS AND CHOROIDAL NEOVASCULARIZATION ( NEOVASCULAR AMD )
-

PATHOGENESIS

VASCULAR INSUFFICIENCY CHANGING HEMODYNAMIC SYSTEM DUE TO ARTERIOSCLEROSIS.

DIAGNOSIS & CLINICAL SIGN

NONNEOVASCULAR AMD REDUCTION IN VISION OR DIFFICULTIES WITH DARK ADAPTATION METAMORPHOPSIA ( AMSLER GRID ) CENTRAL SCOTOMA MICROPSIA

MANAGEMENT

NONNEOVASCULAR ( DRY) - EDUCATION AND FOLLOW UP TO RECOGNIZE SYMPTOM OF ADVANCED AMD. VISION EVALUATION. - AMSLER GRID IMPORTANT TEST FOR VISUAL CHANGES DAILY.

MANAGEMENT
- PREVENTION LASER PHOTOCOAGULATION.

NEOVASCULAR AMD FUNDUS ANGIOGRAPHY LASER PHOTOCOAGULATION FOR EXTRAFOVEAL LESION.

THANK

YOU

POPULATION BASED STUDIES HAVE SHOWN MOSTLY HAVE NONNEOVASVULAR AMD. THE PATIENTS ARE USSUALLY ASYMPTOMATIC OR MILD DECREASE IN VISION AND OR METAMORPHOPSIA. THE ADVANCED ATROPHIC FORM MAY HAVE CENTRAL OR PERICENTRAL SCOTOMA.