Age Related Macular Degeneration (ARMD).pptx

ARMD

1. Age Related Macular Degeneration (ARMD) SHAZIA MEHTAB BSVS (ISO) LECTURER ISO, AIEH KARACHI

2. Contents Introduction Risk factors Types Pathophysiology Drusen CNVM Clinical features Investigations / Treatments Complications

3. Introduction ARMD is an acquired degenerative disease of macula causing an irreversible significant impairment of central vision through a combination of non-neovascular and neovascular derangements

4. Risk factors for ARMD Age Posterior pole drusen Race ( common in Caucasian ) Positive family history Smoking HTN

5. Types Atrophic / Dry ARMD Exudative / Wet ARMD

6. Pathophysiology Development of discrete yellow spots ( drusen ) beneath RPE at macula Hyper/hypopigmentation of RPE Atrophy of RPE, choriocapillaries & photoreceptors

7. Pathophysiology (contd.) Sub-retinal choroidal neovascularization Neovessels lead to edema and exudation Exudative lesion resolve and scar is formed

8. Pathophysiology (contd.) Dry ARMD comprises 90% of total with progressive atrophy of photoreceptors , RPE & choriocapillaries , with no neovessels & edema Wet ARMD comprises remaining 10% with neovessels , edema and ultimate CNVM & PED

9. Drusen Extracellular deposits located at interface between the RPE & Bruch membrane and are thought to be derived from immune-mediated and metabolic processes in RPE Two types of drusen are : Hard drusen Soft drusen

10. Drusen (contd.) Hard drusen Well-defined Soft drusen Less defined Larger than hard drusen

11. Choroidal Neovascular Membrane CNVM is commonly present in wet ARMD and which originating from choriocapillaris which grow through the defects in bruch’s membrane in to the subretinal space

12. Types of CNVM Classic CNVM is well define membrane which may be subfoveal and extrafoveal Occult CVNM is a poorly define membrane

13. Symptoms of ARMD Dry ARMD Gradual impairment of central vision over periods of months/years Metamorphopsia Bilateral /asymmetrical vision loss Wet ARMD Sudden deterioration of central vision Metamorphopsia with asymmetrical involvement of both eyes

14. Signs of ARMD Dry ARMD Focal atrophy of RPE with drusens at macula Well-circumscribed areas of RPE atrophy with variable loss of choriocapillaries Geographical atrophy of RPE with disappearance of drusens & visibility of choroidal vessels Wet ARMD Fluid accumulation gives well-circumscribed dome shaped elevation Choroidal neovessels on macula cause exudation & hemorrhage Fibrous macular scar with resolution of exudate and hemorrhage

15. Investigations Dry ARMD FFA shows window defect Wet ARMD FFA confirms the suspected CNV & its precise localization Classic CNVM Occult CNVM ICGA OCT

16. Treatments Dry ARMD Prophylactic treatment i.e antioxidants , vitamins & minerals ( vitamin C and E , beta carotene , zinc , copper & lutein) Low vision aids

17. Treatments (contd.) Wet ARMD Anti-VEGF agents Bevacizumab Ranibizumab Pegaptanib Triamcinolone acetonide

18. Treatments (contd.) 2. Argon laser photocoagulation Effective for early cases Indicated for juxtafoveal & extra foveal CNVs 3. Photodynamic Therapy Indicated for subfoveal CNVs 4.Transpupillary thermotherapy For subfoveal occult CNVs

19. Treatments (contd.) 5. Surgery Sub-macular surgery Macular translocation

20. Complications Sub-retinal hemorrhage Vitreous hemorrhage Diplopia ( dragged-fovea diplopia syndrome ) Legal blindness ( 79-90% in wet ARMD )