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Classification
- Difference between dry and wet AMD
- Dry
- early AMD: multiple small drusen <63um or some medium-sized drusen 63-125um
- intermediate AMD: at least 1 large drusen >125um or ≥ 20 medium-sized drusen 63-125um.
- Advanced AMD with geographic atrophy
- Wet
- Advanced AMD with choroidal neovascularisation (CNV)
Symptoms
- Central visual loss, metamorphopsia, reading difficulties
Examination
- Visual acuity reduced, Amsler grid with metamorphopsia
- Fundoscopy
- OCT
- Dry: Drusen, retinal pigment epithelial detachments (PEDs), Atrophy
- Wet: intra-/subretinal fluid, CNV membrane
- Fluorescence angiography: gold standard for the detection of wet AMD
Differential Diagnosis
- Central Serous Chorioretinopathy (CSCR)
- Myopic Choroidal Neovascularisation
- Polypoidal Choroidal Vasculopathy (PCV)
Treatment
- Dry AMD: smoking cessation, optimisation of cardiovascular risk factors, vitamin supplementation according to AREDS-2 (see below), low-vision counselling
- Wet AMD: intravitreal anti-VEGF injections (e.g. Lucentis, Eylea), usually according to a treat & extend regimen
Vitamin supplementation according to AREDS-2
- Original AREDS-2 Formula
- Vitamin C 500 mg
- Vitamin E 400 IU
- Zinc 80 mg
- Copper 2 mg
- Lutein 10 mg
- Zeaxanthin 2 mg
- Indication (in AREDS-2 study)
- Patients aged 50 to 85 with bilateral intermediate AMD or advanced AMD in 1 eye
- Supplements with AREDS-2 Formula
- e.g. Bausch & Lomb: PreserVision AREDS 2 or Protina Trophosan Visiobalance
Follow-up
- Dry AMD: 6-12 months with Amsler grid self-monitoring
- Wet AMD: initially monthly, extension of injection interval as soon as stable (various regimens possible)
Sources
- EyeWiki Age-related macular degeneration
- The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilkins; 7th Edition (2016)
- Kanski’s Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8th Edition (2015)
- The Age-Related Eye Disease Study 2 (AREDS2) Research Group*. Lutein + Zeaxanthin and Omega-3 Fatty Acids for Age-Related Macular Degeneration: The Age-Related Eye Disease Study 2 (AREDS2) Randomized Clinical Trial. JAMA. 2013;309(19):2005–2015. doi:10.1001/jama.2013.4997
- AREDS2 Research Group; Chew EY, Clemons T, SanGiovanni JP, Danis R, Domalpally A, McBee W, Sperduto R, Ferris FL. The Age-Related Eye Disease Study 2 (AREDS2): study design and baseline characteristics (AREDS2 report number 1). Ophthalmology. 2012 Nov;119(11):2282-9. doi: 10.1016/j.ophtha.2012.05.027. Epub 2012 Jul 26.