Exudative (Wet) Age-Related Macular Degeneration (AMD) Clinical Presentation

Updated: Oct 09, 2019
  • Author: F Ryan Prall, MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
  • Print
Presentation

History

Patients with age-related maculopathy 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 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. [50]

Next:

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.

Previous
Next:

Causes

In addition to age (see Age), strong risk factors include the following: family history, [26, 51] white race, [16] and a history of tobacco use. [52, 53]

Other risk factors reported fairly consistently include hypertension. [16, 54]

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. [55]

Patients with AMD, glaucoma, or diabetic retinopathy should be asked about cognitive status, as these degenerative diseases have been linked to Alzheimer disease. [50]

Previous