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llddmd-gcm10
Older age group Prevalence increases past the age of 55 Gradually progressive simultaneous or sudden
sequential deterioration of central vision in both eyes. Distortion or abnormal size of images. No pain or redness. Macular abnormalities seen by ophthalmoscopy.
retinal pigment epithelium, choriocapillaris complex in the central retina (macula) Divided into exudative or wet and nonexudative or dry Other associated factors are race (usually white), sex (slight female predominance), family history, a history of cigarette smoking, nutrition, scleral rigidity, photic exposure, hypertension
Exudative changes
Hemorrhage Hard exudates Subretinal & subretinal pigment epithelium & intraretinal fluid Incipient Geographic
Atrophy
Drusen
Character for age-related
maculopathy
Hard drusen:
Large, confluent soft drusen are particularly associated with exudative age-related macular degeneration.
Clinical Findings
Exudative Degeneration / WET EXUDATIVE
choroidal new vessels grow between the retinal pigment epithelium and Bruch's membrane, leading to accumulation of serous fluid, hemorrhage, and fibrosis onset of visual loss is more rapid and more severe in exudative degeneration than in atrophic degeneration accounts for about 90% of all cases of legal blindness due to age-related macular degeneration
Clinical Findings
Atrophic Degeneration / DRY NONEXUDATIVE
characterized by gradually progressive bilateral visual loss of moderate severity due to atrophy and degeneration of the outer retina and retinal pigment epithelium
Symptoms
Visual Blurring
Central Scotomas Metamorphosia Visual distortion
Micropsia images may appear smaller Macropsia images may appear larger
Antioxidant Supplementation
Combination Therapy Intravitreal injection of the corticosteroid triamcinolone acetonide (usually 4 mg) has been combined with photodynamic therapy Genetic Approaches Adenoviral vector-mediated intravitreal gene transfer of pigment-epitheliumderived factor, an antiangiogenic cytokine, appears to help arrest the growth of choroidal neovascularization in humans
Intraocular Devices Implantable miniature telescopes Surgical implantation of optic-nerve, cortical, subretinal, and epiretinal electrically stimulated devices