AGE RELATED MACULAR

DEGENERATION(ARMD)

KEERTHI N S2010 BATCH

ARMD

• Leading cause of blindness • Senile• Bilateral disease of persons over 50 yrs• White People and females

Etiology

Age related condition

RISK FACTORS Heredity Smoking Hypertension Excessive exposure to sunlight Nutrition

PATHOGENESIS

• Sclerosis of arteries which nourishes the retina

Clinical types

• Non exudative [dry] 90%

• Exudative [wet] 10%

Dry ARMD

Insufficient oxygen and nutrients

damages photoreceptor molecules

With ageing, the ability of RPE cells to digest these molecules decreases

Excessive accumulation of residual bodies (drusen)

RPE membrane and cells degenerate and atrophy sets in and central vision is lost

• Drusen: – Small ,yellowish deposits on Bruch’s membrane– Derived from metabolic products of visual receptors and

retinal pigment epithelium – Deposited as mucopolysaccharides and lipids

Wet ARMD

Photoreceptors and pigment epithelium send distress signal to choriocapillaries

New vessels grow behind the macula

Blood vessels are fragile

Blood and fluid leakage

Scarring of macula

Potential for rapid severe damage

• Hemorrhagic pigment epithelial detachment - dark elevated mount

SYMPTOMS OF ARMD

• CENTRAL LOSS OF VISION

• Distorted vision• Seeing straight line as

wavy

• No PERIPHERAL VISUAL DEFECTS

DIAGNOSIS

1)Slit lamp examination(macula)

2)Fundus Fluorescein Angiography, Indocyanine Green Angiography(choroidal neo-Vascularization

3) Optical coherance tomography(sub retinal fluid , intra retinal thickening , choroidal neovascularisation and hemorrhages in wet ARMD

OCT

Non-Exudative(DRY)

Exudative (WET)

90% 10%

SeverityPathogenesis

Symptoms

Signs

Treatment

Non-Exudative(DRY)

Exudative (WET)

90% 10%

Severity Less severe more

Pathogenesis Symptoms

Signs

Treatment

Non-Exudative(DRY)

Exudative (WET)

90% 10%

Severity Less severe more

Pathogenesis Thinning of macula & deposits and pigmentation of macula

Choroidal neo-vasularisation; friable leak blood and fluid

Symptoms Signs

Treatment

Non-Exudative(DRY)

Exudative (WET)

90% 10%

Severity Less severe more

Pathogenesis Thinning of macula & deposits and pigmentation of macula

Choroidal neo-vasularisation; friable leak blood and fluid

Symptoms Gradual loss of vision Sudden painless loss of vision

Signs

Treatment

Non-Exudative(DRY)

Exudative (WET)

90% 10%

Severity Less severe more

Pathogenesis Thinning of macula & deposits and pigmentation of macula

Choroidal neo-vasularisation; friable leak blood and fluid

Symptoms Gradual loss of vision Sudden painless loss of vision

Signs Drusen and loss of pigments in retina

Elevation in neurosensory retina or pigment epithelium beneath which abnormal blood, fluid and haemorrhage

Treatment

Non-Exudative(DRY)

Exudative (WET)

90% 10%

Severity Less severe more

Pathogenesis Thinning of macula & deposits and pigmentation of macula

Choroidal neo-vasularisation; friable leak blood and fluid

Symptoms Gradual loss of vision Sudden painless loss of vision

Signs Drusen and loss of pigments in retina

Elevation in neurosensory retina or pigment epithelium beneath which abnormal blood, fluid and haemorrhage

Treatment Zn supplemetation and antioxidant vitamins

Laser Photo coagulationPhotodynamnic therapyTranspupillary thermotherapySubmacular and macular translocation surgery