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Key Features

  • Age-related macular degeneration is the leading cause of permanent visual loss in the older population

  • Precursor is the development of age-related maculopathy, characterized by retinal drusen

  • Two subtypes: dry (atrophic) and wet (neovascular)

Clinical Findings

  • Loss of central vision

  • Dry subtype is characterized by progressive, bilateral visual loss of moderate severity resulting from atrophy and degeneration of the outer retina and retinal pigment epithelium

  • Wet subtype is characterized by rapid and severe unilateral visual loss, with a high risk of subsequent involvement of the fellow eye

  • Older patients in whom sudden central visual loss develops, particularly paracentral distortion or scotoma with preservation of central acuity, should be referred urgently to an ophthalmologist for assessment

Diagnosis

  • On ophthalmoscopic examination, various abnormalities are visualized in the macula

  • Fundal photography after intravenous fluorescein (fluorescein angiography) is often required

Treatment

  • In wet degeneration, inhibitors of vascular endothelial growth factor (VEGF) (including ranibizumab [Lucentis], pegaptanib [Macugen], bevacizumab [Avastin], or aflibercept [VEGF Trap-Eye, Eylea])

    • Reverse the choroidal neovascularization and stabilize vision

    • Long-term repeated intraocular injections are required

    • Treatment is well tolerated with minimal adverse effects

    • However, there is a risk of intraocular complications

  • No dietary modification has been shown to prevent the development of age-related maculopathy

  • Oral treatment with antioxidants (vitamins C and E), zinc, copper and carotenoids (lutein and zeaxanthin, rather than vitamin A [beta-carotene]) is recommended to reduce the risk of progression to advanced disease

  • Oral omega-3 fatty acids do not provide additional benefit

  • Macular surgery may be beneficial in bilateral severe disease

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