eMedicine Specialties > Ophthalmology > Retina

ARMD, Nonexudative: Follow-up

Author: Raj K Maturi, MD, Clinical Associate Professor, Volunteer, Department of Ophthalmology, Indiana University School of Medicine; Retina Service, Midwest Eye Institute, Indianapolis, IN
Contributor Information and Disclosures

Updated: Feb 22, 2010

Follow-up

Further Outpatient Care

  • Patients with dry age-related macular degeneration (ARMD) should be observed frequently. Their follow-up care should be determined by the extent of disease and by the ophthalmologist's assessment of risk of conversion to wet ARMD.
  • Daily Amsler grid evaluation is necessary, with immediate reports to the ophthalmologist of any changes are noted.

Inpatient & Outpatient Medications

  • No approved medications for the treatment of dry age-related macular degeneration (ARMD) are available.

Complications

  • The major complication of dry age-related macular degeneration (ARMD) is the conversion to wet (or exudative/neovascular) ARMD.

Prognosis

  • Prognosis for this disease is significantly better than the prognosis for wet age-related macular degeneration (ARMD). Patients likely will have steadily but slowly deteriorating visual acuity. It also is common to have other visual dysfunction (eg, loss of ability to quickly adapt to changing lighting conditions, loss of contrast sensitivity). Variability of vision from day-to-day is common.

Patient Education

  • Patients with geographic atrophy (GA) may have a variety of visual dysfunction. The location of atrophy often suggests the type of visual dysfunction that will be experienced by the patient. Many patients with age-related macular degeneration (ARMD) report difficulty in adjusting to changing light conditions; specifically, they take a significantly longer time to adjust to indoor lighting after being outside in bright sunlight. Wrap-around outdoor sunglasses that have an orange tint work for some patients.
  • Patients who primarily have central atrophy often note trouble with reading and performing fine motor tasks. Magnification and increased contrast (via a monitor or increased illumination) are the best solutions for such visual dysfunction.
  • In contrast, other patients have GA that spares the foveal center but affects the entire perifoveal region. These patients often can see 20/20, but they are unable to navigate due to the small area of good visual acuity. Some of these patients have to scan the screen to be able to see the 20/400 character. In these patients, excess magnification would be detrimental, because it would effectively decrease their limited visual field. Increased contrast and minification, by way of increased illumination and reverse telescopes respectively, may be beneficial for these patients.
  • Referral to comprehensive vision rehabilitation is indicated early in the disease process. The American Academy of Ophthalmology (AAO) recommends referral for vision rehabilitation when acuity is less than 20/40 or when a loss of contrast sensitivity, scotoma, or field loss is noted. The aim of early referral is to prevent the many negative consequences of vision loss. For example, when acuity is reduced to 20/50 or worse, patients have twice the risk of falling, 3 times the risk of depression, and 4 or greater times the risk of hip fracture. Rehabilitation aims to maximize patients’ use of their partial vision and to provide practical adaptation to reduce disability. Comprehensive rehabilitation addresses the “whole person,” as outlined in the AAO’s booklet of Vision Rehabilitation for Adults. Barriers to low-vision therapy access include poor insurance coverage and transportation.14
  • For excellent patient education resources, visit eMedicine's Eye and Vision Center. Also, see eMedicine's patient education article Macular Degeneration.

Miscellaneous

Medicolegal Pitfalls

  • Examining patients who report a new onset of symptoms in a timely manner is imperative. Patients should be examined for neovascular changes and treated appropriately.
 


More on ARMD, Nonexudative

Overview: ARMD, Nonexudative
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Treatment & Medication: ARMD, Nonexudative
Follow-up: ARMD, Nonexudative
Multimedia: ARMD, Nonexudative
References
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References

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  17. Christen WG, Glynn RJ, Chew EY, Albert CM, Manson JE. Folic acid, pyridoxine, and cyanocobalamin combination treatment and age-related macular degeneration in women: the Women's Antioxidant and Folic Acid Cardiovascular Study. Arch Intern Med. Feb 23 2009;169(4):335-41. [Medline].

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  27. Mitchell P, Smith W, Attebo K, Wang JJ. Prevalence of age-related maculopathy in Australia. The Blue Mountains Eye Study. Ophthalmology. Oct 1995;102(10):1450-60. [Medline].

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  29. Sunness JS. The natural history of geographic atrophy, the advanced atrophic form of age-related macular degeneration. Mol Vis. Nov 3 1999;5:25. [Medline]. [Full Text].

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Further Reading

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Keywords

nonexudative ARMD, nonexudative age-related macular degeneration, nonexudative AMD, age-related macular degeneration, AMD, dry macular degeneration, macular degeneration, senile macular degeneration, geographic atrophy, drusen, drusenoid changes, pigment epithelial degeneration, photodynamic therapy, PDT, transpupillary thermotherapy, TTT, IRIS medical laser, rheopheresis, complications of age-related macular degeneration prevention trial, CAPT, drusen ablation, laser to drusen, CNFT, intraocular implant,  CHF, complement factor H gene

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Contributor Information and Disclosures

Author

Raj K Maturi, MD, Clinical Associate Professor, Volunteer, Department of Ophthalmology, Indiana University School of Medicine; Retina Service, Midwest Eye Institute, Indianapolis, IN
Raj K Maturi, MD is a member of the following medical societies: American Academy of Ophthalmology and American Society of Retina Specialists
Disclosure: Eli Lilly Consulting fee Consulting; Allergan Grant/research funds Consulting; DRCR/National Eye Institute, NIH Consulting fee Consulting

Medical Editor

Brian A Phillpotts, MD, Former Vitreo-Retinal Service Director, Former Program Director, Clinical Assistant Professor, Department of Ophthalmology, Howard University College of Medicine
Brian A Phillpotts, MD is a member of the following medical societies: American Academy of Ophthalmology, American Diabetes Association, American Medical Association, and National Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Steve Charles, MD, Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine; Adjunct Professor of Ophthalmology, Columbia College of Physicians & Surgeons; Clinical Professor Ophthalmology, Chinese University of Hong Kong
Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Club Jules Gonin, Macula Society, and Retina Society
Disclosure: Alcon Laboratories Consulting fee Consulting; OptiMedica Ownership interest Consulting

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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