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For further information, see CMDT Part 7-16: AGE-RELATED MACULAR DEGENERATION

Key Features

Essentials of Diagnosis

  • Older age group

  • In one or both eyes; acute or chronic deterioration of central vision; distortion or abnormal size of images, sometimes developing acutely

  • No pain or redness

  • Classified as dry ("atrophic," "geographic") or wet ("neovascular," "exudative") macular degeneration

  • Macular abnormalities seen by ophthalmoscopy

General Considerations

  • Both dry age-related and wet age-related macular degeneration are progressive and usually bilateral; however, manifestations, prognosis, and management differ

  • Although dry age-related macular degeneration is much more common, untreated wet age-related macular degeneration accounts for about 90% of all cases of legal blindness due to age-related macular degeneration


  • Leading cause of permanent visual loss in the older population

  • Prevalence progressively increases over age 50 years (to almost 30% by age 75)

  • Occurrence and response to treatment are likely influenced by genetically determined variations, many of which involve the complement pathway

  • Other associated factors

    • Sex (slight female predominance)

    • Family history

    • Hypertension

    • Hypercholesterolemia

    • Cardiovascular disease

    • Farsightedness

    • Light iris color

    • Cigarette smoking

Clinical Findings

  • Retinal drusen are the hallmark of age-related macular degeneration

    • Hard drusen appear ophthalmoscopically as discrete yellow subretinal deposits

    • Soft drusen are paler and less distinct

    • Large, confluent soft drusen are risk factors for neovascular (wet) age-related macular degeneration

  • Vision loss in age-related macular degeneration involves the central field of vision only in most patients

  • Peripheral fields, and hence navigational vision, are maintained, except in patients with severe neovascular age-related macular degeneration

  • Dry age-related macular degeneration

    • Gradual progressive bilateral visual loss of moderate severity due to geographic atrophy of the

      • Outer retina

      • Retinal pigment epithelium

      • Choriocapillaris, which supplies blood to both the outer retina and the retinal pigment epithelium

  • Wet (neovascular) age-related macular degeneration

    • Onset of visual loss is more rapid and more severe than in atrophic degeneration

    • New choroidal vessels grow under either the retina or the retinal pigment epithelial cells, leading to accumulation of exudative fluid, hemorrhage, and fibrosis

    • The two eyes are frequently affected sequentially over a period of a few years


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

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


  • Dry age-related macular degeneration: No specific treatment

  • Wet age-related macular degeneration

    • Rehabilitation including low-vision aids is important

    • VEGF inhibitors, such as ranibizumab, bevacizumab, aflibercept, and brolucizumab can cause regression of choroidal neovascularization with resorption of subretinal fluid and improvement or stabilization of vision; however, brolucizumab has been associated with intraocular inflammation and occlusive retinal vasculitis resulting in irreversible vision loss in some patients

    • Long-term repeated intraocular injections are required and must be administered in the eye clinic several times a year, if not monthly

  • No ...

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