ARMD: Age-Related Macular Degeneration Course
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Questions and Answers

What is the diameter of the fovea?

  • 1.5-2mm (correct)
  • 2.5-3mm
  • 2-2.5mm
  • 1-1.5mm

    • What is the structure at the center of the foveola?

  • Umbo (correct)
  • Fovea
  • Foveal margin
  • Parafovea

    • What is the characteristic age range for Age-related Macular Degeneration (ARMD)?

  • 60 years or older
  • 50 years or older (correct)
  • 40-50 years
  • 30-40 years

    • What is the possible progression of Early ARMD?

    <p>To either dry or exudative ARMD</p> Signup and view all the answers

    What is the region surrounding the fovea?

    <p>Parafovea</p> Signup and view all the answers

    What is the term for the characteristic changes in the central or macular retina?

    <p>Age-related Macular Degeneration</p> Signup and view all the answers

    What is the primary cause of ARMD, according to the text?

    <p>Aging changes</p> Signup and view all the answers

    What is the prevalence of ARMD among individuals aged 80+yrs?

    <p>59%</p> Signup and view all the answers

    What is the 5-year cumulative incidence of late ARMD in individuals >75yrs?

    <p>2.4%</p> Signup and view all the answers

    What is the estimated total number of individuals with ARMD in the UK?

    <p>1,908,524</p> Signup and view all the answers

    What is the role of the retinal pigment epithelium (RPE) in the pathophysiology of ARMD?

    <p>To remove outer segments of photoreceptor cells</p> Signup and view all the answers

    What is the result of incomplete phagocytosis of outer segments by RPE cells?

    <p>Accumulated debris in RPE or Bruch's membrane</p> Signup and view all the answers

    What is the prevalence of bilateral ARMD in individuals >65yrs in the European Eye Study?

    <p>1.4%</p> Signup and view all the answers

    What is the ranking of ARMD as a cause of blindness worldwide?

    <p>Third</p> Signup and view all the answers

    What is the proportion of certified sight impaired or severely sight impaired individuals due to ARMD in the UK?

    <p>30-49%</p> Signup and view all the answers

    What is the result of the accumulation of debris in RPE or Bruch's membrane?

    <p>Drusen formation</p> Signup and view all the answers

    What is the main function of melanin in RPE cells?

    <p>To scavenge free radicals and absorb light</p> Signup and view all the answers

    What is the typical appearance of hard drusen?

    <p>Yellowish, round, with distinct edges</p> Signup and view all the answers

    What is the primary consequence of lipofuscin accumulation in the RPE?

    <p>Diminished retinal sensitivity with increased autofluorescence</p> Signup and view all the answers

    What is the primary purpose of fundus fluorescein angiography (FFA) in ARMD?

    <p>To detect leakage of fluorescein only in abnormal leaky blood vessels</p> Signup and view all the answers

    What is the typical size of hard drusen found in isolation?

    <p>Less than 50µm</p> Signup and view all the answers

    What is the primary role of the retinal pigment epithelium (RPE) in ARMD?

    <p>To phagocytose photoreceptor outer segments</p> Signup and view all the answers

    What is the typical appearance of soft drusen?

    <p>Larger, yellowish, with indistinct confluent edges</p> Signup and view all the answers

    What is the primary purpose of optical coherence tomography (OCT) in ARMD?

    <p>To measure central retinal thickness</p> Signup and view all the answers

    What is the primary consequence of oxidative damage in the RPE?

    <p>Decreased RPE function</p> Signup and view all the answers

    What is the primary purpose of taking a detailed ocular history in patients with ARMD?

    <p>To identify risk factors and monitor disease progression</p> Signup and view all the answers

    What is the main indicator of early ARMD?

    <p>Soft Drusen</p> Signup and view all the answers

    What is the main difference between early and late ARMD?

    <p>Presence of RPE atrophy</p> Signup and view all the answers

    What is the term for the thinning of the RPE and choroidal circulation?

    <p>Geographic Atrophy</p> Signup and view all the answers

    What is the primary symptom of late dry ARMD?

    <p>Severe reading difficulties</p> Signup and view all the answers

    What is the classification system used for Choroidal Neovascular Membranes (CNV)?

    <p>By location (subfoveal, juxtafoveal, extrafoveal)</p> Signup and view all the answers

    What is the median time to developing central GA after any GA diagnosis in at least one eye?

    <p>2.5 years</p> Signup and view all the answers

    What is the term for the process of Drusen becoming larger and merging?

    <p>Confluence</p> Signup and view all the answers

    What is the main risk factor for progression to Exudative ARMD?

    <p>Drusen size (&gt;63 µm)</p> Signup and view all the answers

    What is the term for the 'window defect' seen in OCT?

    <p>Geographic Atrophy</p> Signup and view all the answers

    What is the median time to development of bilateral GA?

    <p>7 years</p> Signup and view all the answers

    What should a patient with dry AMD do if they experience a sudden change in their eyesight?

    <p>Attend an optometric practice within 24 hours</p> Signup and view all the answers

    Why should patients with dry AMD be actively checked for exudative change?

    <p>Because they can change to exudative AMD</p> Signup and view all the answers

    What should be provided to patients with dry AMD to aid in monitoring their condition?

    <p>An Amsler chart</p> Signup and view all the answers

    What is the benefit of early referral to the Low Vision Service for patients with AMD?

    <p>It provides significant support for daily living</p> Signup and view all the answers

    What should be explained to patients with dry AMD?

    <p>The difficulties they may experience with faces and reading</p> Signup and view all the answers

    Why is a thorough history and symptoms essential for patients with ARMD?

    <p>To ensure effective management and referral</p> Signup and view all the answers

    What is the primary effect of VEGF on blood vessels?

    <p>Increased permeability and angiogenesis</p> Signup and view all the answers

    What is the mechanism of action of anti-VEGF therapy in exudative ARMD?

    <p>Inhibition of VEGF binding to receptors to prevent angiogenesis</p> Signup and view all the answers

    What is the advantage of Lucentis over other anti-VEGF agents?

    <p>It has a higher affinity for all VEGF-A forms</p> Signup and view all the answers

    What is the primary outcome of treatment with anti-VEGF therapy in exudative AMD?

    <p>Stabilization of lesions and reduction of leakage</p> Signup and view all the answers

    What is the recommended referral pathway for patients with exudative AMD and good visual acuity?

    <p>Urgent referral to the specialist macular clinic/unit</p> Signup and view all the answers

    What is the role of Aflibercept in the treatment of exudative AMD?

    <p>It traps VEGF and prevents angiogenesis</p> Signup and view all the answers

    What is the primary goal of treatment in exudative AMD?

    <p>To slow the progression of vision loss</p> Signup and view all the answers

    What is the recommended management approach for patients with dry AMD?

    <p>Referral to the low vision services</p> Signup and view all the answers

    What is the benefit of using Lucentis in the treatment of exudative AMD?

    <p>It has good retinal penetration and minimal systemic penetration</p> Signup and view all the answers

    What is the prognosis of exudative AMD without treatment?

    <p>Rapid decline in vision to hand movements</p> Signup and view all the answers

    Study Notes

    Anatomy Revision

    • Fovea: 1.5 to 2mm, more heavily pigmented than surrounding retinal tissue
    • Parafovea surrounds the fovea
    • Retina is thick at the foveal margin and thins towards the central depression of the fovea (foveola)
    • Umbo is at the centre of the foveola
    • Definition: disorder apparent after 50 years with characteristic changes of the central or macular retina
    • Classification: Early ARMD progresses to Late ARMD (Dry or Exudative)
    • Early ARMD: soft drusen, RPE changes (hyperpigmentation or hypopigmentation)
    • Late ARMD (Dry): geographic atrophy, RPE and choroidal thinning
    • Late ARMD (Exudative): choroidal neovascular membrane (CNV), pigment epithelial detachments, sub-RPE neovascularisation

    Epidemiology of ARMD

    • Worldwide: 5% of blindness (WHO Global Data on Visual Impairment 2010)
    • Ranked third in world cause of blindness
    • Prevalence increases with age, 1 in 2 to 1 in 3 people present with any ARMD (Early or Late)
    • Higher in females and Caucasians
    • 2.1 million individuals in EU nations have ARMD in at least one eye

    Aetiology of ARMD

    • Due to aging changes, genetic factors (e.g. Apolipoprotein E gene), modifiable factors (e.g. diet, lifestyle)
    • Risk factors: age, gender, race, hereditary factors, light exposure, smoking, social status, cardiovascular and cerebrovascular disease

    Pathophysiology of ARMD

    • Role of retinal pigment epithelium (RPE): phagocytosis and removal of outer segments of photoreceptor segments
    • With age, RPE cells reduce in number and density, leading to accumulation of debris (drusen)
    • Drusen: hard, small, and yellowish; soft, larger, and confluent
    • Oxidative damage and melanin accumulation contribute to RPE atrophy and photoreceptor degeneration

    Optometric Investigation of ARMD

    • History and symptoms: description of visual change, duration, progression, and impact on daily living
    • Key investigations: distance and near subjective refraction, pupil reflexes, Van Hericks, and dilated fundus examination
    • Imaging: digital fundus photography, fundus fluorescein angiography, indocyanine green angiography, and optical coherence tomography

    Late Dry ARMD

    • Clinical features: geographic atrophy, RPE and choroidal thinning
    • Symptoms: severe reading difficulties due to paracentral/central scotoma
    • Progression: gradual decline in vision over time, ring macular scotoma with atrophy

    Late Exudative ARMD

    • Clinical features: choroidal neovascular membrane, pigment epithelial detachments, sub-RPE neovascularisation
    • Symptoms: rapid onset of distortion, central/paracentral scotoma
    • Treatment: anti-VEGF therapy to reduce leakage and slow progression

    Management and Referral

    • Early detection and referral crucial for exudative ARMD
    • Referral to low vision services for dry ARMD
    • Patient education: diet, smoking, eye examination, family history, UV protection, and supplements

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    Description

    Test your knowledge on Age-Related Macular Degeneration (ARMD) covering anatomy, classification, epidemiology, aetiology, pathophysiology, risk factors, optometric investigation, and treatment. This course is designed for biomedical sciences and optometry students.

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