Age related macular degeneration (ARMD)

It is leading causes of irreversible severe visual loss.

Usually bilateral

The presence of some degree of visual loss in association with drusen, geographic atrophy  of  R.P.E or change associated with subretinal neovascularization in individual above 50 years

   TYPES

1. Non exudative 90%
2. Exudative 10%

Pathogenesis

1)drusen

2)degenerative changes in RPE

3)subretinal neovascular membrane.    

   

1)  Drusen: deposition of abnormal waste products in bruch membrane derived from metabolic activity of retinal pigment epithelium .

2) Degenerative changes in R.P.E

The degenerative changes manifest as clumps of hyperpigmented or depigmented atrophic areas.

3) subretinal neovascularization: 20% of eyes develops subretinal neovascularization. SRNV may be associated with sub retinal hemorrhage ,fibrosis, pigment epithelial degeneration and photopigment atrophy

Dry ARMD – RPE atrophy

Symptoms;

Impairment of central vision and metamorphopsia

SIGNS

1. focal hyperpigmentation or atrophy of RPE 
2. drusen.
3. hemorrhage or exudation macular area
4. fibous disciform scar
5. Metamorphopsia &
   central scotoma

Investigation

FFA ( Fundus flourescein angiography)

      for localization of SRNV

Treatment

1. argon laser photocoagulation
2. photodynamic therapy
3. Low vision aids; high plus magnifier, telescope
4. Anti- VEGF intravitreal injection
5. Steroid intravitreal injection