Most common cause of blindness in individuals over 65 years in developed countries
Aetiology
- Not clear - age-related, underlying inflammatory process
Risk factors
- Increasing age
- Smoking
- Positive family history
- Poor nutrition
Pathophysiology
Dry ARMD (~90%)
- Deposition of drusden (accumulation of byproducts - proteins, lipids, and inflammatory mediators) in RPE and between RPE and Bruch membrane results in slow progressive atrophy of the lical RPE
Wet ARMD (~10%)
- Neovascularisation in choroid, mediated by VEGF
- New vessels are small and fragile → more likely to haemorrhage so more likely to result in visual loss
Clinical presentation
Wet ARMD
- Rapid central visual loss
- Distortion (metamorphopsia)
Dry ARMD
- Gradual decline in vision
- Central vision 'missing' (scotoma)
Investigations
Fundoscopy
Wet ARMD
- Haemorrhage/exudate
Dry ARMD
- Drusen
- Atrophic patches of retina
Wet ARMD
Fluorescein angiography
OTC
Management
Wet ARMD
- Anti-VEGF
Dry ARMD
- No cure - treatment is supportive with low vision aids e.g. magnifiers
- Magnifiers increase retinal image size, making object easier to see as scotoma stays the same size
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