Degenerative Retinal Disorders 337 1245 Age Related Macular Degeneration Definition

Progressive degeneration of the macula in elderly patients.

Epidemiology: Age-related macular degeneration is the most frequent cause of blindness beyond the age of 65 years.

Pathogenesis: Drusen develop in the retinal pigment epithelium due to accumulation of metabolic products.

Symptoms: Patients notice a gradual loss of visual acuity. Where macular edema is present, patients complain of image distortion (metamorphopsia), macropsia, or micropsia.

Findings and diagnostic considerations: Ophthalmoscopic examination can distinguish two separate stages that occur in chronological order (Table 12.6).

Differential diagnosis: Other vascular diseases of the retina such as branch retinal vein occlusion should be excluded by ophthalmoscopy. Malignant melanoma should be excluded by ultrasound studies.

Treatment: No reliably effective medical therapy is available. Laser therapy may be performed in the exudative stage in about 5-10% of all patients without neovascularization involving the fovea centralis. Use of progressively stronger near vision aids such as a hand magnifier or binocular magnifier should be tried.

Clinical course and prognosis: The course of the disorder is chronic and leads to progressive loss of visual acuity.

H Laser therapy may be performed in the exudative stage of late age-related macular degeneration in 10% of all patients provided the disorder is diagnosed early.

Table 12.6 Stages of age-related macular degeneration (ARM) Stage Characteristics

1. Early ARM: Drusen, atrophy, and proliferation of retinal pigment epithelium

2. Late ARM: Geographic atrophy (Fig. 12.27 a) of the retinal pigment epithelium. Serous detachment of the retina and/or retinal pigment epithelium; hemorrhages (Fig. 12.27 b). Fibrous scar (Fig. 12.27 c)

338 12 Retina Stages of late age-related macular degeneration.

Drusen Macular Degeneration Definition

Fig. 12.27

a Late age-related macular degeneration: Typical signs include drusen (arrow) and geographically central atrophy (arrowhead).

c Late age-related macular degeneration: The fibrous scar is a typical sign.

Fig. 12.27

a Late age-related macular degeneration: Typical signs include drusen (arrow) and geographically central atrophy (arrowhead).

b Late age-related macular degeneration: Intraretinal bleeding (arrow) is a typical sign.

c Late age-related macular degeneration: The fibrous scar is a typical sign.

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