Podcast
Questions and Answers
What is a common symptom of advanced age-related macular degeneration (AMD)?
What is a common symptom of advanced age-related macular degeneration (AMD)?
- Enhanced vision in low light
- Blind spots in or around central vision (correct)
- Increased color perception
- Improved visual acuity over time
Which of the following tests is NOT typically used in the diagnosis of AMD?
Which of the following tests is NOT typically used in the diagnosis of AMD?
- Dilated eye exam with slit lamp
- Visual acuity test
- Blood pressure measurement (correct)
- Amsler grid testing
What is the primary goal of therapy for age-related macular degeneration?
What is the primary goal of therapy for age-related macular degeneration?
- Minimize and slow the progression of vision loss (correct)
- Completely restore vision
- Increase the number of visual function tests
- Eliminate all symptoms of AMD
Which statement about the causes of age-related macular degeneration is true?
Which statement about the causes of age-related macular degeneration is true?
What functional difficulties may arise due to AMD?
What functional difficulties may arise due to AMD?
What is the primary mechanism of action for VEGF inhibitors in the treatment of choroidal neovascular membranes?
What is the primary mechanism of action for VEGF inhibitors in the treatment of choroidal neovascular membranes?
How often are intravitreal injections of VEGF inhibitors administered after the initial treatment period?
How often are intravitreal injections of VEGF inhibitors administered after the initial treatment period?
Which of the following is NOT a common adverse drug reaction (ADR) associated with VEGF inhibitors?
Which of the following is NOT a common adverse drug reaction (ADR) associated with VEGF inhibitors?
Which VEGF inhibitor was introduced most recently in Canada?
Which VEGF inhibitor was introduced most recently in Canada?
What is a significant financial consideration for patients receiving VEGF inhibitor treatment?
What is a significant financial consideration for patients receiving VEGF inhibitor treatment?
What was the main aim of the AREDS study?
What was the main aim of the AREDS study?
In the AREDS study, what percentage of participants were female?
In the AREDS study, what percentage of participants were female?
Which nutrient was eliminated from the AREDS 2 formulation due to safety concerns?
Which nutrient was eliminated from the AREDS 2 formulation due to safety concerns?
How many participants were involved in the AREDS study?
How many participants were involved in the AREDS study?
What was one of the main components of the AREDS Formula?
What was one of the main components of the AREDS Formula?
What additional substances were tested in AREDS 2 to assess their effect on AMD progression?
What additional substances were tested in AREDS 2 to assess their effect on AMD progression?
What was the total amount of Vitamin E used in the original AREDS formula?
What was the total amount of Vitamin E used in the original AREDS formula?
What was the goal regarding the formulations in AREDS 2?
What was the goal regarding the formulations in AREDS 2?
What is the estimated global prevalence of age-related macular degeneration (AMD) in 2020?
What is the estimated global prevalence of age-related macular degeneration (AMD) in 2020?
Which of the following is NOT a risk factor for developing AMD?
Which of the following is NOT a risk factor for developing AMD?
What are the two key parts of the retina affected by AMD?
What are the two key parts of the retina affected by AMD?
Which stage of AMD is characterized by the presence of drusen?
Which stage of AMD is characterized by the presence of drusen?
What is the estimated increase in the number of people expected to have AMD by 2040?
What is the estimated increase in the number of people expected to have AMD by 2040?
What is the term used for advanced AMD characterized by the growth of new blood vessels?
What is the term used for advanced AMD characterized by the growth of new blood vessels?
Which statement accurately describes the impact of AMD on global healthcare costs?
Which statement accurately describes the impact of AMD on global healthcare costs?
What primary vision function is affected by the macula, which undergoes breakdown in AMD?
What primary vision function is affected by the macula, which undergoes breakdown in AMD?
What was the primary aim of the Cochrane Review concerning antioxidant vitamin and mineral supplements?
What was the primary aim of the Cochrane Review concerning antioxidant vitamin and mineral supplements?
Which vitamin supplementation is reported to probably slow down the progression to late AMD and vision loss?
Which vitamin supplementation is reported to probably slow down the progression to late AMD and vision loss?
What was found regarding the effect of vitamin E on the development of AMD?
What was found regarding the effect of vitamin E on the development of AMD?
How does beta-carotene supplementation affect individuals who smoke or have asbestos exposure?
How does beta-carotene supplementation affect individuals who smoke or have asbestos exposure?
What was the significance of lutein supplementation in AMD according to the study?
What was the significance of lutein supplementation in AMD according to the study?
How many studies did Cochrane researchers analyze to determine the effects of supplements on AMD?
How many studies did Cochrane researchers analyze to determine the effects of supplements on AMD?
Which statement reflects the findings regarding vitamin C supplementation?
Which statement reflects the findings regarding vitamin C supplementation?
What conclusion can be drawn regarding the adverse effects of antioxidant vitamins and minerals?
What conclusion can be drawn regarding the adverse effects of antioxidant vitamins and minerals?
What is the effect of omega-3 supplements on the risk of progression to advanced AMD?
What is the effect of omega-3 supplements on the risk of progression to advanced AMD?
Which group is advised to avoid the AREDS formula with beta-carotene?
Which group is advised to avoid the AREDS formula with beta-carotene?
Which of the following statements is true about the effect of AREDS and AREDS2 on cataracts?
Which of the following statements is true about the effect of AREDS and AREDS2 on cataracts?
What was one of the main findings regarding lutein and zeaxanthin supplementation for participants with low dietary levels?
What was one of the main findings regarding lutein and zeaxanthin supplementation for participants with low dietary levels?
What was observed when comparing AREDS2 containing lutein and zeaxanthin to the original AREDS with beta-carotene?
What was observed when comparing AREDS2 containing lutein and zeaxanthin to the original AREDS with beta-carotene?
Which statement best describes the effectiveness of removing beta-carotene or reducing zinc in the AREDS2 formulation?
Which statement best describes the effectiveness of removing beta-carotene or reducing zinc in the AREDS2 formulation?
What is the main purpose of AREDS and AREDS2 supplements?
What is the main purpose of AREDS and AREDS2 supplements?
How does AREDS2 compare to the original AREDS formula concerning AMD progression risk?
How does AREDS2 compare to the original AREDS formula concerning AMD progression risk?
Flashcards
What is AMD?
What is AMD?
Age-related macular degeneration (AMD) is an eye disease that affects the central part of the retina, called the macula. It leads to blurred or distorted central vision, making it difficult to see fine details.
Dry AMD
Dry AMD
Dry AMD is the most common type, affecting 80% of cases. It occurs when the macula, responsible for sharp central vision, thins with age. Tiny clumps of protein (drusen) form beneath the retina, leading to a slow deterioration of central vision.
What is the prevalence of AMD?
What is the prevalence of AMD?
The prevalence of AMD refers to the percentage of people in a population who have the disease. It's estimated to be around 8.7% globally, affecting millions of people.
What is dry AMD?
What is dry AMD?
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Wet AMD
Wet AMD
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Macula Thinning
Macula Thinning
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What is wet AMD?
What is wet AMD?
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Drusen
Drusen
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What are some risk factors for AMD?
What are some risk factors for AMD?
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What are drusen?
What are drusen?
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Symptoms of AMD
Symptoms of AMD
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What is the macula?
What is the macula?
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How is AMD classified?
How is AMD classified?
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What is Age-related Macular Degeneration (AMD)?
What is Age-related Macular Degeneration (AMD)?
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What is early AMD?
What is early AMD?
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What is late AMD?
What is late AMD?
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What are antioxidants?
What are antioxidants?
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What is a Cochrane Review?
What is a Cochrane Review?
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What are antioxidant vitamins and minerals?
What are antioxidant vitamins and minerals?
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What is an antioxidant vitamin and mineral supplement?
What is an antioxidant vitamin and mineral supplement?
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Age-Related Eye Disease Study (AREDS)
Age-Related Eye Disease Study (AREDS)
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Study Population
Study Population
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Intervention
Intervention
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Age-Related Macular Degeneration (AMD)
Age-Related Macular Degeneration (AMD)
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AREDS Formula
AREDS Formula
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AREDS 2
AREDS 2
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Primary AREDS 2 Formulation
Primary AREDS 2 Formulation
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Secondary AREDS 2 Formulations
Secondary AREDS 2 Formulations
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VEGF Inhibitors
VEGF Inhibitors
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How are VEGF Inhibitors Dosed?
How are VEGF Inhibitors Dosed?
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What are the potential side effects of VEGF Inhibitors?
What are the potential side effects of VEGF Inhibitors?
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What are the benefits of using VEGF Inhibitors?
What are the benefits of using VEGF Inhibitors?
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What is a cost-related limitation of VEGF Inhibitors?
What is a cost-related limitation of VEGF Inhibitors?
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What is the recommended AMD treatment for smokers?
What is the recommended AMD treatment for smokers?
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Can AMD be prevented with supplements?
Can AMD be prevented with supplements?
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Do AMD supplements affect cataracts?
Do AMD supplements affect cataracts?
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Do omega-3s help with AMD?
Do omega-3s help with AMD?
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Which is better - AREDS or AREDS2?
Which is better - AREDS or AREDS2?
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Should people already on multivitamins take AMD supplements?
Should people already on multivitamins take AMD supplements?
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Should patients with one eye affected by AMD take supplements?
Should patients with one eye affected by AMD take supplements?
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Who should take AREDS2 supplements?
Who should take AREDS2 supplements?
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Study Notes
Age-Related Macular Degeneration (AMD)
- AMD is a leading cause of vision loss in older adults
- Prevalence is approximately 8.7% globally in 2020
- Estimated global cost of visual impairment due to AMD is over $300 billion in 2040
- More prevalent in European or North American ancestry
- Similar prevalence between men and women
- Increasing age (typically 55+) is a major risk factor
Learning Objectives
- Describe AMD pathophysiology, etiology, epidemiology, classification, and diagnosis
- Identify risk factors for AMD diagnosis and progression considering specific patient factors
- List patient-specific goals of therapy for AMD
- Explain AMD to a patient and discuss common supplements used in treatment and prognosis
- Recommend micronutrient supplementation to a specific patient considering available evidence for effectiveness and potential adverse effects
- Describe the role of VEGF inhibitors and their place in therapy for AMD
Pathophysiology & Etiology
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Two key parts of the retina are the macula and peripheral retina
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The macula provides central vision, color vision, and fine detail perception
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It has the highest concentration of photoreceptor cells
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AMD occurs when there is a breakdown of the macula
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AMD is classified by stages: early, intermediate, and advanced. Advanced AMD can be wet or dry.
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Early: characterized by the presence of drusen
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Intermediate: large drusen and/or pigment changes in the retina
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Wet: involves neovascularization (the growth of abnormal blood vessels), fluid leakage and scarring of the macula
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Dry: macular thinning with the growth of protein clumps called drusen, slow loss of central vision
Clinical Presentation & Diagnosis
- Early or intermediate AMD is often asymptomatic.
- Symptoms can include blurred or decreased vision, distortion, blind spots (scotomas), difficulty with visual function in daily activities like reading and driving
- Diagnosis: detailed clinical history and comprehensive eye tests
- Tests include: visual acuity, Amsler grid testing, and dilated eye exam with slit lamp
Goals of Therapy
- Minimize/slow vision loss progression
- Minimize enlargement of central scotomas
- Resolve leakage of blood vessels in the macula and hemorrhage associated with neovascular AMD
- Optimize function and quality of life, e.g., driving, favorite activities, mobility
Nonpharmacologic/Lifestyle Options
- Quit smoking (or don't start)
- Regular physical activity
- Maintain normal blood pressure and cholesterol levels
- Eat a healthy diet, rich in green leafy vegetables and fish
- Consult an occupational therapist (OT) or low vision clinic for setting up home to cope with low vision
Treatment Algorithm
- Includes micronutrient supplementation, vascular endothelial growth factor (VEGF) inhibitors, and photodynamic therapy
- For dry AMD: urge patients to quit smoking; vitamin & mineral therapy; monitor vision with an Amsler grid; refer for low-vision clinic
- For wet AMD: refer to a retinal specialist; optical coherence tomography + fluorescein angiogram; consider intravitreal VEGF inhibitor; re-evaluate every 1–2 months until stable (OCT testing and no recent visual changes); monitor vision with Anmsler grid if vision permits
Micronutrient (Antioxidant and Mineral) Supplementation
- AREDS (Age-Related Eye Disease Study) Formula includes: Vitamin C, Vitamin E, beta-carotene, zinc, and copper
- AREDS2 Formula: tweaked the original AREDS formula; removed beta-carotene portion due to lung cancer risk in smokers.
- Supplements do not prevent AMD onset, but can reduce the risk of progression from intermediate to advanced AMD.
Pharmacologic Options: VEGF Inhibitors
- Inhibit growth and regress new choroidal neovascular (CNV) blood vessels
- Dosed by intravitreal injection every few weeks (initial injections)
- Common adverse reactions include mild eye pain, subconjunctival hemorrhage, endophthalmitis, and retinal detachment
- Agents in Canada: bevacizumab, ranibizumab, aflibercept, brolucizumab, faricimab. Expensive
Patient Case: Tom
- Information about Tom Provo's case and recommendations for treatment are needed to complete these notes. The summary only provides a title and the question "What will we recommend?"
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