Age-related macular degeneration

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Summary of Age-related macular degeneration

Macular degeneration, also known as age-related macular degeneration, is a medical condition which may result in blurred or no vision in the center of the visual field. Early on there are often no symptoms. Over time, however, some people experience a gradual worsening of vision that may affect one or both eyes. While it does not result in complete blindness, loss of central vision can make it hard to recognize faces, drive, read, or perform other activities of daily life. Visual hallucinations may also occur but these do not represent a mental illness.

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Age-related macular degeneration

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OTHER DIAGNOSTICS ▪ Clinical presentation: history; ↓ visual acuity, visual ﬁelds (central vision loss) TREATMENT MEDICATIONS ▪ Exudative ARMD ▫ Intravitreal injections of VEGF antagonists to reduce neovascularization ▫ Alternative: photodynamic therapy; injection of photosensitive dye verteporﬁn → damages neovascular endothelium; application of photoactivating laser Figure 77.1 Drusen in the macula of individual with age-related macular degeneration. OTHER INTERVENTIONS ▪ No curative method; therapy aimed at slowing progression ▪ Vitamin, antioxidant supplements ▪ Nonexudative ARMD ▫ Smoking cessation CATARACT osms.it/cataract PATHOLOGY & CAUSES ▪ Painless, gradual decline in vision due to opaciﬁcation of lens ▪ Proteins deposit on lens → reduce transmission of light to retina → decrease in vision ▪ Often bilateral but asymmetrical; congenital/ acquired TYPES Nuclear ▪ Opaciﬁcation of lens nucleus ▪ Slow progression of vision loss Cortical ▪ Opaciﬁcation of lens ﬁbers surrounding 600 OSMOSIS.ORG nucleus (cortex) ▪ Mild degradation of vision Posterior subcapsular ▪ Opaciﬁcation in posterior cortical layer under lens capsule ▪ Rapid progression RISK FACTORS ▪ Age-related cataract; usually > 60 ▪ Smoking, excessive alcohol use, prolonged drug use (esp. glucocorticoids), exposure to UV light, eye trauma/infections, radiation of intraocular tumor, trisomies (13, 18, 21) ▪ Metabolic diseases: diabetes mellitus, Wilson disease, galactosemia, myotonic dystrophy

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Age-related macular degeneration

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The most common type of age-related macular degeneration is the (wet/dry) type.

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A 79-year-old woman comes to the clinic because of rapid distortion of vision in her right eye over the past several weeks. She reports a slowly progressive decrease in visual acuity when reading, specifically in her left eye that she got used to by using brighter light. She thought it was just due to old age and has not followed up with an ophthalmologist. Her acute changes in the right eye have alarmed her and she is afraid of blindness. Her temperature is 37.0°C (98.6°F), pulse is 82/min, respirations are 12/min, and blood pressure is 128/86 mm Hg. Physical examination shows deposits of extracellular material collecting into yellowish deposits seen by using ophthalmoscopy. Which of the following would best treat her acute visual changes in her right eye?

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