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Exudative ARMD Clinical Presentation

  • Author: F Ryan Prall, MD; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: May 20, 2016
 

History

Patients with ARM are often asymptomatic or sometimes notice mild symptoms, including minimally blurred central visual acuity, contrast and color disturbances, and mild metamorphopsia (distorted vision). If geographic atrophy develops in the macular region, patients may notice a scotoma (blind spot), which can slowly enlarge over months to years before eventually stabilizing.

Patients with exudative AMD typically describe painless progressive blurring of their central visual acuity, which can be acute or insidious in onset. Patients who develop subretinal hemorrhage from CNV, for example, typically report an acute onset. Other patients with CNVM may experience insidious blurring secondary to shallow subretinal fluid or pigment epithelial detachments (PEDs). They also report relative or absolute central scotomas, metamorphopsia, and difficulty reading.

The natural history of exudative AMD or occasionally nonexudative AMD results in a stable central scotoma in which the visual acuity falls below the reading level and the legal driving level. However, peripheral visual acuity is usually retained.

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Physical

AMD occurs bilaterally, but it is often asymmetric. Visual acuity is variably reduced. Amsler grid testing typically reveals relative central scotomas or metamorphopsia.

The sine qua non of exudative AMD is CNVM. Eyes with exudative AMD present with subretinal fluid, retinal PEDs, subretinal hemorrhage, and, occasionally, subretinal lipid deposits. In addition, RPE hypertrophy, RPE atrophy, and drusen are usually present. The CNV itself may be seen as yellow-green subretinal discoloration and is sometimes surrounded by a pigment ring. Subretinal hemorrhage typically develops at the margins of the CNV and sometimes obscures the entire complex. On occasion, the subretinal hemorrhage can progress and lead to vitreous hemorrhage. Subretinal disciform scarring of the macula is a common end-stage morphology.

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Causes

In addition to age (see Age), strong risk factors include the following: family history,[28, 52] white race,[18] and a history of tobacco use.[53, 54]

Other risk factors reported fairly consistently include hypertension.[18, 55]

The role of dietary fat intake has been studied extensively. Studies have indicated that diets high in total fat and trans-fat may increase risk of AMD, while diets high in omega-3 fatty acids and fish may lower risk.[56]

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Contributor Information and Disclosures
Author

F Ryan Prall, MD Assistant Professor of Ophthalmology, Indiana University School of Medicine

F Ryan Prall, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Coauthor(s)

Thomas A Ciulla, MD, MBA Staff Physician and Surgeon, Indiana University Health System, Beltway Surgery Centers, LLC, and St Vincent Hospital; Staff Physician and Retina Specialist, Midwest Eye Institute

Thomas A Ciulla, MD, MBA is a member of the following medical societies: Alpha Omega Alpha, Association for Research in Vision and Ophthalmology, American Academy of Ophthalmology, American Diabetes Association, Indiana Academy of Ophthalmology, Indianapolis Ophthalmological Society, Macula Society, Retina Society, Society of Heed Fellows

Disclosure: Nothing to disclose.

Mark H Criswell, PhD Adjunct Assistant Research Professor, Department of Ophthalmology, Indiana University School of Medicine

Mark H Criswell, PhD is a member of the following medical societies: Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Alon Harris, PhD Lois Letzter Professor, Director of Glaucoma Research and Diagnostic Center, Department of Ophthalmology, Indiana University School of Medicine

Alon Harris, PhD is a member of the following medical societies: American College of Sports Medicine, American Physiological Society, American Society for Laser Medicine and Surgery, New York Academy of Sciences

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Steve Charles, MD Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine

Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Macula Society, Retina Society, Club Jules Gonin

Disclosure: Received royalty and consulting fees for: Alcon Laboratories.

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, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Brian A Phillpotts, MD, MD 

Brian A Phillpotts, MD, MD is a member of the following medical societies: American Academy of Ophthalmology, American Diabetes Association, American Medical Association, National Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Grant M Comer, MD, to the development and writing of this article.

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Age-related macular degeneration (AMD), exudative.
Age-related macular degeneration (AMD), exudative.
Color photograph of the fundus shows nonexudative age-related macular degeneration (AMD) with geographic atrophy of the retinal pigment epithelium (RPE) and drusen. Absolute atrophy of the RPE occupies the foveal region in this case of nonexudative AMD. The central atrophic region causes a corresponding central scotoma. Note the large choroidal vessels, which are visible through the RPE defect. Drusen surround the region of geographic atrophy. Photo by Tim Steffens.
 
 
 
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