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Sections Exudative (Wet) Age-Related Macular Degeneration (AMD)
- Overview
- Presentation
- DDx
- Workup
- Treatment
- Medication
- Questions & Answers
- Media Gallery
- References
History
Patients with age-related maculopathy often are 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 age-related macular degeneration (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.
An association between AMD and Alzheimer disease has been reported. [48]
Physical
AMD occurs bilaterally, but it often is 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 usually are 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.
Causes
In addition to age (see Age), strong risk factors include the following: family history, [25, 49] White race, [15] and a history of tobacco use. [50, 51]
Hypertension is another risk factor that is reported fairly consistently. [15, 52]
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 for AMD, whereas diets high in omega-3 fatty acids and fish may lower risk. [53]
Patients with AMD, glaucoma, or diabetic retinopathy should be asked about cognitive status, as these degenerative diseases have been linked to Alzheimer disease. [48]
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Age-related macular degeneration (AMD), exudative.
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Age-related macular degeneration (AMD), exudative.
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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.
Tables
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.
Thomas A Ciulla, MD, MBA Clinical Professor (Volunteer) of Ophthalmology, Indiana University School of Medicine; Ophthalmologist, Vitreoretinal Medicine and Surgery, Midwest Eye Institute
Thomas A Ciulla, MD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Society of Gene and Cell Therapy, American Society of Retina Specialists, Association for Research in Vision and Ophthalmology, Indiana Academy of Ophthalmology, International Society for Genetic Eye Diseases and Retinoblastoma, Macula Society, Retina Society
Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Ophthotech Corp.; Spark Therapeutics; Clearside Biomedical<br/>Received income in an amount equal to or greater than $250 from: Ophthotech Corp.; Spark Therapeutics; Clearside Biomedical.
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 Founder and CEO of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine
Disclosure: Received royalty and consulting fees for: Alcon Laboratories.
Andrew A Dahl, MD, FACS Assistant Professor of Surgery (Ophthalmology), New York College of Medicine (NYCOM); Director of Residency Ophthalmology Training, The Institute for Family Health and Mid-Hudson Family Practice Residency Program; Staff Ophthalmologist, Telluride Medical Center
Andrew A Dahl, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Intraocular Lens Society, American Medical Association, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Medical Society of the State of New York, New York State Ophthalmological Society, Outpatient Ophthalmic Surgery Society
Disclosure: Nothing to disclose.
Brian A Phillpotts, MD Ophthalmologist, St Luke's Cataract and Laser Institute
Brian A Phillpotts, MD is a member of the following medical societies: American Academy of Ophthalmology, American Diabetes Association, American Society of Retina Specialists, Association for Research in Vision and Ophthalmology, Association of University Professors of Ophthalmology
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.
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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Sections Exudative (Wet) Age-Related Macular Degeneration (AMD)
- Overview
- Presentation
- DDx
- Workup
- Treatment
- Medication
- Questions & Answers
- Media Gallery
- References
