L1 Macula

Question 1

What is early AMD?

Answer 1

• Dry changes (soft drusen, hyper and hypo pigmentation of RPE)

Question 2

What is late AMD?

Answer 2

• Either: End stage dry AMD (geographic atrophy) or presence of
  neovascular AMD

Question 3

AREDS classification of AMD

Answer 3

Question 4

Risk factors of AMD

Answer 4

Question 5

why do we get drusen?

Answer 5

1.damage to photoreceptor by oxidative stress

RPE cells force out unwanted or damaged proteins or lipids that can accumulate in brutes membrane

Question 6

What is drusen?

Answer 6

abnormal lipid deposits generated by photoreceptors.

between the basal lamina of the RPE and the inner collagenous layer of Bruch’s membrane

pale yellow

Question 7

What causes Dry AMD?

Question 8

What are the symptoms of Dry AMD?

Answer 8

-gradual impairment of vision
-later stages:
+ve scotoma
difficulty recognising faces
-difficulty seeing in dim light
painless

Question 9

What are the signs of Dry AMD?

Answer 9

hard/soft drusen

focal hypo/hyper pigmentation of RPE

geographic atrophy
drusenoid rpe detachment (later stages ^)

Question 10

What are the differences between hard and soft drusen?

Answer 10

hard:

• small yellow/white spots
  -part of normal age processing of eye
  -less than half retinal vein width

soft
thickening of Bruch’s membrane

-Larger in size, may coalesce to form confluent drusen ( >125 micron)

Can form drusenoid pigment epithelium detachment

-should be monitored

Question 11

soft drusen

Question 12

hard drusen

Question 13

what is hyper pigmentation?

image

Answer 13

RPE cell proliferationRPE cell migration
Increase in melanin in RPE cells

Question 14

What is hypopigmentation?

image

Answer 14

seen as small patches of mottled pigment RPE layer thinning

RPE cell atrophy
Reduction in melanin in RPE cells

Question 15

What is Geographic atrophy ?

Answer 15

1.atrophic areas enlarge and coalesce
2. underlying choroidal vasculature becomes visible

3. Advanced GA: visible scleral tissue, loss of drusen,
   severe central vision impairment

Question 16

What is the prognosis or Dry AMD

Answer 16

➢Visual loss is gradual

• Can take approx 10 years to reduce to 6/60 vision or less
  *
  Central visual loss only – peripheral vision remains intact
• Can try and develop eccentric viewing
• Try low vision aids

Question 17

What is the differential diagnosis of Dry AMD?

Answer 17

• Myopic degeneration
• CSCR
• Toxic retinopathies
  (chloroquine,bulls eye macuopathy
• Inflammatory maculopathies ( choroiditis, rubella)

Question 18

How is Wet AMD caused?

Question 19

What are the symptoms of Wet AMD?

Question 20

What are the signs of Wet AMD?

Question 21

What is this?

Answer 21

Pigment epithelium detachment (PED)- when RPE is separated from bucks membrane

on an OCT it looks like a dome shaped elevation of the RPE

Question 22

Why do we get PED?

Question 23

Answer 23

serous pd
Orange/pale dome-shaped elevated lesion of
variable size

• Smooth contours, sharply delineated edges
• Hypo-fluorescence on OCT

transilluminate if filled with serous fluid

Question 24

Answer 24

drusenoid ped

hyper reflective red

often seen in Dry AMD due to confluent drusen

Drusenoid PEDs appear as yellow or yellow–white elevations of the RPE that are usually found within the macula. They may have scalloped borders and a slightly irregular surface

Question 25

Answer 25

firbrovascular ped

Question 26

The space between the rpe and brutes membrane can be occupied by

Answer 26

Serous exudate * Drusen * Fibrovascular tissue * Blood (or a combination of these)

Question 27

What is choroidal neovascular membrane?

Answer 27

Abnormal growth of vessels from the choroidal vasculature to the neurosensory retina (through Bruch's membrane). Choroidal neovascular membranes (CNVM) is the abnormal growth of blood vessels beneath the retina. These blood vessels grow in the choroid and break through the bruchs membrane . When they leak or bleed in the retina they cause vision loss (They break through the barrier between the choroid and the retina. )

Question 28

Answer 28

CNVM

Question 29

How do we get drusenoid PED

Answer 29

-As the soft drusen coalesce and accumulate RPE can separate from Bruch’s -no leakage visible on OCT or FFA * Differential diagnosis: Choroidal neovascularisation (neovascular AMD)

Question 30

Why do we get hypo/hyper pigmentation?

Answer 30

1. drusen blocks transportation of metabolites 2. stops nutrients going to RPE 3. rpe dies off 4. causing hypo/hyper pigmentation

Question 31

What are the 3 types of CNVM?

Answer 31

Type 1 occult Type 2 classic Type 3 Retinal Angiomatous Proliferation (RAP)”)

Question 32

Which classification of CNVM is this

Answer 32

Type 1 occult neovascular membrane is located below the RPE.

Question 33

Which classification of CNVM is this?

Answer 33

Type 2 ("classic") new vessels pass through the RPE thus is located above the RPE in the subretinal space.

Question 34

Which classification of CNVM is this?

Answer 34

Type 3 (“Retinal Angiomatous Proliferation (RAP)” neovascularization that originates from the retinal capillaries, within the neurosensory retina (and not from the choroid) that progresses posteriorly into the subretinal space.

Question 35

CNVM appearance

Answer 35

Dirty grey-green colour (sub- retinal brighter than sub-RPE) * Slightly elevated, dome shaped, subtle to detect * Often accompanied by haemorrhages and/or exudates (but not always) * Classify as either ‘Classic CNV’ or ‘Occult CNV’ on FFA