Age-related macular degeneration

Age-related macular degeneration is defined as changes which occur in the central area of the retina (=macula) in individuals aged over 50 without any obvious cause.

It is the leading cause of blindness in the UK.

Risk factors
  • Smoking 
  • Increasing age 
  • Family history 
  • Caucasian 
  • Previous cataract surgery

2 types:
  • Dry 
    • Characterised by drusen = lipid material in Bruch’s membrane 
    • Often asymptomatic 
  • Wet 
    • Characterised by choroidal neovascularisation – new vessels are fenestrated so allow blood to leak, leading to macular haemorrhage 
    • worse prognosis

  • Dry 
    • Often detected on routine fundoscopy 
    • If fovea involved – deterioration of central vision 
  • Wet 
    • Central visual blurring, straight lines appear wavy 
    • Decreased vision

  • Dry and wet:
    • Smoking cessation
    • Diet 
      • Diet rich in fruit and vegetables (antioxidant vitamins) and oily fish (omega 3 fatty acids) – not conclusively proven to help but thought to be beneficial
      • AREDS formula – very high dose antioxidants (vitamin C, vitamin E, beta-carotene) and zinc
        • Beta-carotene is contra-indicated in smokers as increases the risk of lung cancer
        • Vitamin E associated with increased risk of heart failure in individuals with diabetes or vascular disease (HOPE study)
  • Wet only:
    • Intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) – such as ranibizumab 
    • Argon laser
    • Photosensitising dye (verteporfin) then laser

Small print gem: Patients with visual loss such as macular degeneration may suffer from visual hallucinations. This is known as Charles Bonnet Syndrome.

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