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?

Tiny clumps of protein can lead to central vision loss. Signup and view all the answers

What functional difficulties may arise due to AMD?

Challenges with driving and reading in poorly lit settings Signup and view all the answers

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

Inhibiting the formation of new blood vessels by lowering VEGF levels Signup and view all the answers

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

Every 4 to 8 weeks Signup and view all the answers

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

Nausea and vomiting Signup and view all the answers

Which VEGF inhibitor was introduced most recently in Canada?

Brolucizumab Signup and view all the answers

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

Each injection costs up to $1500 and may not be covered Signup and view all the answers

What was the main aim of the AREDS study?

To determine if specific micronutrient supplementation can prevent visual loss Signup and view all the answers

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

56% Signup and view all the answers

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

Beta Carotene Signup and view all the answers

How many participants were involved in the AREDS study?

3,640 Signup and view all the answers

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

Zinc Signup and view all the answers

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

Lutein and Zeaxanthin Signup and view all the answers

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

400 IU Signup and view all the answers

What was the goal regarding the formulations in AREDS 2?

To determine if the changes would lead to a safer but equally effective product Signup and view all the answers

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

Approximately 190 million Signup and view all the answers

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

High physical activity Signup and view all the answers

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

Macula and Peripheral Retina Signup and view all the answers

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

Early AMD Signup and view all the answers

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

From 190 million to 288 million Signup and view all the answers

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

Neovascular AMD Signup and view all the answers

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

Total costs exceed $300 billion, with more than $250 billion in direct healthcare costs Signup and view all the answers

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

Color vision and fine detail Signup and view all the answers

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

To assess the impact on AMD progression and visual loss in affected individuals Signup and view all the answers

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

Antioxidant vitamins combined with zinc Signup and view all the answers

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

It has no effect on the chances of developing AMD Signup and view all the answers

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

It increases the risk of lung cancer Signup and view all the answers

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

It has no effect on progression to late AMD Signup and view all the answers

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

5 studies for healthy individuals and 19 studies for affected individuals Signup and view all the answers

Which statement reflects the findings regarding vitamin C supplementation?

It has no significant impact on developing AMD Signup and view all the answers

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

Adverse effects were not consistently reported, but beta-carotene has risks in specific populations Signup and view all the answers

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

They have no effect. Signup and view all the answers

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

Current or former smokers Signup and view all the answers

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

They do not influence cataracts at all. Signup and view all the answers

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

It helped lower the risk of advanced AMD. Signup and view all the answers

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

AREDS2 led to a reduction in risk of advanced AMD. Signup and view all the answers

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

It had no significant impact on effectiveness. Signup and view all the answers

What is the main purpose of AREDS and AREDS2 supplements?

To reduce risk of progression from intermediate to advanced AMD. Signup and view all the answers

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

AREDS2 is better than AREDS in reducing risk. Signup and view all the answers

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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Description

This quiz covers key concepts related to Age-Related Macular Degeneration (AMD), including its pathophysiology, risk factors, and treatment options. You will learn about the prevalence of AMD, patient-specific goals, and the role of therapies, including VEGF inhibitors. Test your understanding and application of AMD knowledge in clinical practice.