Age-Related Macular Degeneration (AMD) Quiz

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Questions and Answers

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?

  • 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?

  • 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?

<p>Tiny clumps of protein can lead to central vision loss. (B)</p> Signup and view all the answers

What functional difficulties may arise due to AMD?

<p>Challenges with driving and reading in poorly lit settings (A)</p> Signup and view all the answers

What is the primary mechanism of action for VEGF inhibitors in the treatment of choroidal neovascular membranes?

<p>Inhibiting the formation of new blood vessels by lowering VEGF levels (C)</p> Signup and view all the answers

How often are intravitreal injections of VEGF inhibitors administered after the initial treatment period?

<p>Every 4 to 8 weeks (C)</p> Signup and view all the answers

Which of the following is NOT a common adverse drug reaction (ADR) associated with VEGF inhibitors?

<p>Nausea and vomiting (C)</p> Signup and view all the answers

Which VEGF inhibitor was introduced most recently in Canada?

<p>Brolucizumab (D)</p> Signup and view all the answers

What is a significant financial consideration for patients receiving VEGF inhibitor treatment?

<p>Each injection costs up to $1500 and may not be covered (D)</p> Signup and view all the answers

What was the main aim of the AREDS study?

<p>To determine if specific micronutrient supplementation can prevent visual loss (D)</p> Signup and view all the answers

In the AREDS study, what percentage of participants were female?

<p>56% (C)</p> Signup and view all the answers

Which nutrient was eliminated from the AREDS 2 formulation due to safety concerns?

<p>Beta Carotene (C)</p> Signup and view all the answers

How many participants were involved in the AREDS study?

<p>3,640 (D)</p> Signup and view all the answers

What was one of the main components of the AREDS Formula?

<p>Zinc (C)</p> Signup and view all the answers

What additional substances were tested in AREDS 2 to assess their effect on AMD progression?

<p>Lutein and Zeaxanthin (C)</p> Signup and view all the answers

What was the total amount of Vitamin E used in the original AREDS formula?

<p>400 IU (B)</p> Signup and view all the answers

What was the goal regarding the formulations in AREDS 2?

<p>To determine if the changes would lead to a safer but equally effective product (B)</p> Signup and view all the answers

What is the estimated global prevalence of age-related macular degeneration (AMD) in 2020?

<p>Approximately 190 million (B)</p> Signup and view all the answers

Which of the following is NOT a risk factor for developing AMD?

<p>High physical activity (D)</p> Signup and view all the answers

What are the two key parts of the retina affected by AMD?

<p>Macula and Peripheral Retina (C)</p> Signup and view all the answers

Which stage of AMD is characterized by the presence of drusen?

<p>Early AMD (B)</p> Signup and view all the answers

What is the estimated increase in the number of people expected to have AMD by 2040?

<p>From 190 million to 288 million (D)</p> Signup and view all the answers

What is the term used for advanced AMD characterized by the growth of new blood vessels?

<p>Neovascular AMD (C)</p> Signup and view all the answers

Which statement accurately describes the impact of AMD on global healthcare costs?

<p>Total costs exceed $300 billion, with more than $250 billion in direct healthcare costs (C)</p> Signup and view all the answers

What primary vision function is affected by the macula, which undergoes breakdown in AMD?

<p>Color vision and fine detail (C)</p> Signup and view all the answers

What was the primary aim of the Cochrane Review concerning antioxidant vitamin and mineral supplements?

<p>To assess the impact on AMD progression and visual loss in affected individuals (C)</p> Signup and view all the answers

Which vitamin supplementation is reported to probably slow down the progression to late AMD and vision loss?

<p>Antioxidant vitamins combined with zinc (A)</p> Signup and view all the answers

What was found regarding the effect of vitamin E on the development of AMD?

<p>It has no effect on the chances of developing AMD (C)</p> Signup and view all the answers

How does beta-carotene supplementation affect individuals who smoke or have asbestos exposure?

<p>It increases the risk of lung cancer (A)</p> Signup and view all the answers

What was the significance of lutein supplementation in AMD according to the study?

<p>It has no effect on progression to late AMD (C)</p> Signup and view all the answers

How many studies did Cochrane researchers analyze to determine the effects of supplements on AMD?

<p>5 studies for healthy individuals and 19 studies for affected individuals (A)</p> Signup and view all the answers

Which statement reflects the findings regarding vitamin C supplementation?

<p>It has no significant impact on developing AMD (C)</p> Signup and view all the answers

What conclusion can be drawn regarding the adverse effects of antioxidant vitamins and minerals?

<p>Adverse effects were not consistently reported, but beta-carotene has risks in specific populations (A)</p> Signup and view all the answers

What is the effect of omega-3 supplements on the risk of progression to advanced AMD?

<p>They have no effect. (B)</p> Signup and view all the answers

Which group is advised to avoid the AREDS formula with beta-carotene?

<p>Current or former smokers (C)</p> Signup and view all the answers

Which of the following statements is true about the effect of AREDS and AREDS2 on cataracts?

<p>They do not influence cataracts at all. (D)</p> Signup and view all the answers

What was one of the main findings regarding lutein and zeaxanthin supplementation for participants with low dietary levels?

<p>It helped lower the risk of advanced AMD. (B)</p> Signup and view all the answers

What was observed when comparing AREDS2 containing lutein and zeaxanthin to the original AREDS with beta-carotene?

<p>AREDS2 led to a reduction in risk of advanced AMD. (A)</p> Signup and view all the answers

Which statement best describes the effectiveness of removing beta-carotene or reducing zinc in the AREDS2 formulation?

<p>It had no significant impact on effectiveness. (A)</p> Signup and view all the answers

What is the main purpose of AREDS and AREDS2 supplements?

<p>To reduce risk of progression from intermediate to advanced AMD. (D)</p> Signup and view all the answers

How does AREDS2 compare to the original AREDS formula concerning AMD progression risk?

<p>AREDS2 is better than AREDS in reducing risk. (A)</p> Signup and view all the answers

Flashcards

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 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?

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?

Dry AMD is the most common type and occurs when the macula deteriorates slowly due to the buildup of yellowish deposits called drusen. It progresses gradually.

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Wet AMD

Wet AMD is less common but more severe than dry AMD. It involves abnormal blood vessels growing under the retina. These leaky vessels can cause bleeding and fluid buildup, ultimately leading to scarring of the macula and rapid vision loss.

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Macula Thinning

Macula thinning is a key characteristic of dry AMD. It occurs with age and makes the macula more susceptible to damage.

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What is wet AMD?

Wet AMD is rarer but more severe. It happens when abnormal blood vessels grow under the macula, leaking fluid and causing rapid vision loss.

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Drusen

Drusen are tiny yellow deposits that appear under the retina in dry AMD. They contribute to the thinning and deterioration of the macula.

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What are some risk factors for AMD?

Increased age is the most significant risk factor for AMD. Smoking, uncontrolled hypertension, and high BMI also increase the risk.

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What are drusen?

Drusen are small, yellowish deposits that accumulate beneath the retina in early AMD. They are a sign of early disease.

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Symptoms of AMD

Blurred or decreased vision, distortion, and blind spots are common symptoms of AMD. These visual disturbances can impact daily activities.

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What is the macula?

The macula is the central part of the retina responsible for sharp central vision, color vision, and fine detail perception.

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How is AMD classified?

AMD is classified into stages: Early AMD (drusen), Intermediate AMD (larger drusen or pigment changes), and Advanced AMD (wet or dry).

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What is Age-related Macular Degeneration (AMD)?

A medical condition that affects the macula, the central part of the retina, leading to blurred central vision.

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What is early AMD?

A type of AMD where the macula is damaged by a buildup of deposits called drusen.

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What is late AMD?

A more advanced type of AMD where the macula is significantly damaged, potentially leading to vision loss.

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What are antioxidants?

A group of compounds that protect cells from damage caused by free radicals.

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What is a Cochrane Review?

A study designed to assess the effects of a specific intervention, like taking vitamins, on the progression of a disease.

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What are antioxidant vitamins and minerals?

Specific vitamins and minerals that are thought to have antioxidant properties.

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What is an antioxidant vitamin and mineral supplement?

A supplement containing a combination of antioxidant vitamins and minerals.

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Age-Related Eye Disease Study (AREDS)

A research study that investigated the impact of specific micronutrients on the progression of age-related macular degeneration (AMD).

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Study Population

A group of individuals participating in a research study.

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Intervention

A specific intervention or treatment used in a research study.

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Age-Related Macular Degeneration (AMD)

A condition which affects the central part of the retina and can lead to blurred vision.

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AREDS Formula

A specific combination of vitamins and minerals that was found to potentially reduce the risk of AMD progression.

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AREDS 2

A follow-up to the original AREDS study, investigating whether adding lutein, zeaxanthin, and omega-3 fatty acids could reduce the risk of AMD progression.

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Primary AREDS 2 Formulation

A specific combination of nutrients found to be beneficial for AMD, including vitamins C, E, beta-carotene, copper, and zinc.

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Secondary AREDS 2 Formulations

Modified AREDS 2 formulations, exploring different combinations of vitamins and minerals, particularly removing beta-carotene and reducing the dosage of zinc.

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VEGF Inhibitors

Drugs that prevent the growth of new blood vessels in the eye. They are used to treat wet AMD and other eye conditions.

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How are VEGF Inhibitors Dosed?

They are injected directly into the eye, typically every 4 weeks at first, then less often.

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What are the potential side effects of VEGF Inhibitors?

Common side effects of VEGF inhibitors include mild eye pain, bleeding under the conjunctiva, and inflammation inside the eye. In rare cases, they can cause retinal detachment.

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What are the benefits of using VEGF Inhibitors?

They have been shown to improve visual acuity, which means better vision, compared to standard care.

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What is a cost-related limitation of VEGF Inhibitors?

They cost a lot! Each injection can cost up to $1500, and they are not covered by provincial drug plans.

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What is the recommended AMD treatment for smokers?

AREDS2 with lutein and zeaxanthin is the recommended treatment for AMD in current or former smokers as it reduces the risk of progression and does not contain beta-carotene which is linked to increased risk of lung cancer.

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Can AMD be prevented with supplements?

AREDS or AREDS2 supplements do not prevent the initial development of AMD, but they can significantly reduce the risk of the disease progressing from intermediate to advanced stages.

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Do AMD supplements affect cataracts?

Both AREDS and AREDS2 supplements have no influence on the development or progression of cataracts.

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Do omega-3s help with AMD?

Omega-3 fatty acids have no effect on the onset or progression of AMD. They do not help prevent or slow down the disease.

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Which is better - AREDS or AREDS2?

AREDS2 is at least as effective as AREDS with beta-carotene in reducing the risk of AMD progression, making it the preferred choice due to safety concerns.

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Should people already on multivitamins take AMD supplements?

Patients already taking regular multivitamins should also consider taking AREDS2 supplements, as they can provide additional beneficial micronutrients.

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Should patients with one eye affected by AMD take supplements?

Taking AREDS2 supplements is recommended for patients with advanced AMD in one eye, as it can help reduce the risk of the other eye becoming affected.

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Who should take AREDS2 supplements?

People with intermediate or advanced AMD should consider taking AREDS2 supplements in addition to their regular multivitamins.

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Study Notes

  • 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

  • Two key parts of the retina are the macula and peripheral retina

  • The macula provides central vision, color vision, and fine detail perception

  • It has the highest concentration of photoreceptor cells

  • AMD occurs when there is a breakdown of the macula

  • AMD is classified by stages: early, intermediate, and advanced. Advanced AMD can be wet or dry.

  • Early: characterized by the presence of drusen

  • Intermediate: large drusen and/or pigment changes in the retina

  • Wet: involves neovascularization (the growth of abnormal blood vessels), fluid leakage and scarring of the macula

  • 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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