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Age-related Macular Degeneration

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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.

Irreversible central visual loss Age-dependent alterations of the sensory retina,

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

Drusen Pigmentary alterations

Exudative changes

Hemorrhage Hard exudates Subretinal & subretinal pigment epithelium & intraretinal fluid Incipient Geographic

Atrophy

Drusen
Character for age-related

maculopathy

Hard drusen:

ophthalmoscopically discrete yellow deposits less distinct.

Soft drusen: larger, paler, and

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

Lifestyle and Dietary Modifications


Intravitreal Angiogenic Therapy Ranibizumab and Bevacizumab

Ocular Photodynamic Therapy and Argon-Laser

Photocoagulation Therapy Vitreoretinal Surgery

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