Ophthalmology Book

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Age-Related Macular Degeneration

Aka: Age-Related Macular Degeneration, Macular Degeneration, ARMD
  1. Epidemiology
    1. Leading cause of central Vision Loss over age 65 years
    2. Age-related changes
      1. Onset after age 50 years (mean onset: 75 years old)
      2. Prevalence
        1. Sixth decade: 1%
        2. Ninth decade: 15%
  2. Risk Factors
    1. Advancing age (see epidemiology above)
    2. Female sex
    3. White race
    4. Tobacco abuse (increases risk 3 fold)
    5. Diet low in caretenoids
    6. Increased sunlight exposure
    7. Cardiovascular disease
  3. Pathophysiology
    1. Idiopathic
    2. Retinal photoreceptor dysfunction
      1. Results from atrophy or Choroidal neovascularization
      2. Mediators
        1. Subretinal Hemorrhage
        2. Subretinal Fibrosis (disciform scarring)
        3. Subretinal Fluid and lipid accumulation
      3. Outcome: Decreased Visual Acuity to blindness
  4. Types
    1. Non-neovascular (dry) ARMD (80% of all diagnosed cases)
    2. Neovascular ARMD (80% of significant visual Disability)
      1. Choroidal neovascularization (CNV)
  5. Symptoms
    1. Slow, insidious central Vision Loss
  6. Signs: Bilateral eye involvement
    1. Drusen
      1. Debris within Retinal pigment basement membrane
      2. Appear with ophthalmoscope as yellow spots on Retina
      3. Small drusen <63 microns are seen on aging macula
      4. Numerous, large drusen are consistent with ARMD
    2. Geographic atrophy
    3. Serous Retinal pigment epithelial detachment
    4. Choroidal neovascularization
  7. Management: Slow progression of CNV-related Vision Loss
    1. Laser photocoagulation of subretinal blood vessels
    2. Photodynamic therapy
      1. Give IV photosensitive drug (wavelength specific)
      2. Expose eye to targeted wavelength to activate drug
    3. Experimental
      1. External beam radiotherapy
      2. Vitreoretinal microsurgery
  8. Management: Visual aids
    1. Magnifiers
    2. Increased light sources in home environment
  9. Prevention: General measures
    1. Tobacco Cessation is key
    2. See Nutritional Supplements below
  10. Prevention: Nutritional Supplements and Antioxidants
    1. Vitamin C, Vitamin E, Beta Carotene, and Zinc (advanced ARMD - protects other eye)
      1. Vitamin C 500 mg
      2. Vitamin E 400 IU
      3. Beta Carotene 15 mg
      4. Zinc 80 mg (with 2 mg Copper)
      5. (2001) Arch Ophthalmol 119:1417-36
    2. Lutein 10 mg daily
      1. Improves vision in men with Macular Degeneration
      2. Richer (2004) Optometry 75:216-30
  11. Screening
    1. Initiate at age 45 years with dilated exam
  12. References
    1. Martidis in Yanoff (2004) Ophthalmology p. 925-33
    2. Weir (2004) CMAJ 170:463-4

Age related macular degeneration (C0242383)

Definition (MSH) Degenerative changes in the RETINA usually of older adults which results in a loss of vision in the center of the visual field (the MACULA LUTEA) because of damage to the retina. It occurs in dry and wet forms.
Definition (NCI) Age-related loss of vision in the central portion of the retina (macula), secondary to retinal degeneration.
Definition (CHV) A condition in which parts of the eye cells degenerate, resulting in blurred vision and ultimately blindness
Definition (CHV) A condition in which parts of the eye cells degenerate, resulting in blurred vision and ultimately blindness
Definition (CHV) A condition in which parts of the eye cells degenerate, resulting in blurred vision and ultimately blindness
Definition (CHV) A condition in which parts of the eye cells degenerate, resulting in blurred vision and ultimately blindness
Definition (CHV) A condition in which parts of the eye cells degenerate, resulting in blurred vision and ultimately blindness
Definition (CHV) A condition in which parts of the eye cells degenerate, resulting in blurred vision and ultimately blindness
Definition (CHV) A condition in which parts of the eye cells degenerate, resulting in blurred vision and ultimately blindness
Definition (NCI) A condition in which there is a slow breakdown of cells in the center of the retina (the light-sensitive layers of nerve tissue at the back of the eye). This blocks vision in the center of the eye and can cause problems with activities such as reading and driving. Age-related macular degeneration is most often seen in people who are over the age of 50.
Concepts Disease or Syndrome (T047)
MSH D008268
ICD9 362.50
SnomedCT 302891003, 267718000, 193385004, 18222007, 155112007, 193384000
English Degeneration, Macular, Degenerations, Macular, Macular Degeneration, Macular Degenerations, Senile macular retinal degeneration, NOS, SMD - Senile macular degen, AAMD - Age related macular degeneration, MACULAR DEGENERATION, SENILE, MACULOPATHY, AGE-RELATED, 2, MACULAR DEGENERATION, AGE-RELATED, 2, ARMD2, Senile macular degen.unspecif., Unspecified senile macular degeneration, ARMD (age related macular degeneration), senile macular degeneration, Unspecified senile macular degeneration (disorder), Age related macular degeneration (disorder), Age related macular degeneration, AMD-Age-related macular degen, ARMD-Age-related macular degen, Age-related macular degeneratn, MACULAR DEGENERATION AGE RELATED, Macular degeneration NOS, Maculopathy, Age-Related, Macular Dystrophies, Maculopathies, Age Related, Age-Related Macular Degeneration, AGE RELAT MACULOPATHY, Age Related Maculopathies, AGE RELAT MACULOPATHIES, MACULOPATHY AGE RELAT, Macular Degeneration, Age-Related, Macular Degenerations, Age-Related, Age Related Macular Degeneration, Age-Related Macular Degenerations, Degeneration, Age-Related Macular, Degenerations, Age-Related Macular, Age-Related Maculopathy, Macular Dystrophy, Dystrophies, Macular, Maculopathy, Age Related, MACULOPATHIES AGE RELAT, Age-Related Maculopathies, Dystrophy, Macular, Maculopathies, Age-Related, Age Related Maculopathy, Macular Degeneration [Disease/Finding], age related macular degeneration (ARMD), age-related maculopathy, age related maculopathy, macular degeneration, age-related macular degeneration, AMD, ARMD, Macular degeneration (senile) of retina, unspecified, Macular degeneration senile, age related macular degeneration, SMD - Senile macular degeneration, Senile macular degeneration, AMD - Age-related macular degeneration, ARMD - Age-related macular degeneration, Age-related macular degeneration, Age-related macular degeneration (disorder), Senile macular retinal degeneration, Age related macular degeneration (disorder) [Ambiguous], Senile macular degeneration of retina, unspecified
Swedish Makuladegeneration
Spanish degeneración senil de la mácula retiniana, Unspecified senile macular degeneration, Age-related macular degeneration, Senile macular degeneration, Maculopatia Relacionada con la Edad, Maculopatía Relacionada con la Edad, Degeneración macular senil, Degeneración macular asociada a la edad, Degeneración macular (senil) de la retina, no especificada, degeneración macular relacionada con la edad (trastorno), degeneración macular relacionada con la edad, degeneración macular senil, degeneración retiniana macular senil (concepto no activo), degeneración retiniana macular senil (trastorno), degeneración retiniana macular senil, degeneración retinal macular senil, degeneración senil de la mácula retinal, Degeneración Macular, Degeneracion Macular
Czech makulární degenerace, Senilní makulární degenerace, Degenerace makuly spojená s věkem, Makulární (senilní) degenerace sítnice, blíže neurčená
Finnish Makularappeuma
Russian MAKULIARNAIA DEGENERATSIIA, ZHELTOGO PIATNA DISTROFIIA, VMD, ВОЗРАСТНАЯ МАКУЛЯРНАЯ ДЕГЕНЕРАЦИЯ, VOZRASTNAIA MAKULIARNAIA DEGENERATSIIA, ВМД, ЖЕЛТОГО ПЯТНА ДИСТРОФИЯ, МАКУЛЯРНАЯ ДЕГЕНЕРАЦИЯ
Japanese 加齢黄斑変性, 黄斑症-加齢関連, 黄斑変性, 黄斑部変性, 黄斑部変性症, 黄斑変性症, 加齢関連黄斑症, 網膜黄斑変性症, 加令関連黄斑症, ｶﾚｲｵｳﾊﾝﾍﾝｾｲ, ﾛｳｼﾞﾝｾｲｵｳﾊﾝﾍﾝｾｲ, 老人性黄斑変性, 老人性黄斑変性、詳細不明, ﾛｳｼﾞﾝｾｲｵｳﾊﾝﾍﾝｾｲｼｮｳｻｲﾌﾒｲ, 網膜黄斑変性, 黄斑症-加令関連
French DMLA, Dégénérescence maculaire liée à l'âge, Maculopathie liée à l'âge, Dystrophie maculaire, Dégénérescence maculaire (sénile) de la rétine, non précisée, Dégénérescence maculaire sénile, Dégénérescence maculaire, Dégénérescence de la macula
Italian DMLE, Degenerazione maculare legata all'età, Distrofia maculare, AMD, Degenerazione maculare senile, Degenerazioni maculari legate all'età, Degenerazione maculare correlata all'età, Degenerazione senile della macula, Degenerazione maculare (senile) della retina, non specificata, Degenerazione maculare
Portuguese Maculopatia Relacionada a Idade, Degenerescência macular relacionada com a idade, Degenerescência macular senil, Degenerescência senil da mácula, Degenerescência macular (senil) da retina NE, Degeneração Macular
Croatian ŽUTA PJEGA, DEGENERACIJA
Polish AMD, Zwyrodnienie plamki żółtej, Zwyrodnienie plamki żółtej związane z wiekiem
German Makuladegeneration (senil) der Retina, unspezifisch, Makuladegeneration senil, senile Makuladegeneration, altersbedingte Makuladegeneration, Makuladegeneration
Dutch macula degeneratie seniel, seniele macula degeneratie, niet-gespecificeerde macula degeneratie (seniel) van de retina, leeftijdsgebonden maculadegeneratie, Degeneratie, macula-, Maculadegeneratie
Hungarian Macula degeneratio (senilis), nem meghatározott, Életkorhoz kötött macula degeneratio, Senilis macularis degeneratio, Senilis macula degeneratio
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Macular degeneration (C0024437)

Definition (CHV) deterioration of the eye part called macula lutea of the retina
Definition (CHV) deterioration of the eye part called macula lutea of the retina
Definition (CHV) deterioration of the eye part called macula lutea of the retina
Definition (CHV) deterioration of the eye part called macula lutea of the retina
Definition (MEDLINEPLUS)

Macular degeneration, or age-related macular degeneration (AMD) is a leading cause of vision loss in Americans 60 and older. It is a disease that destroys your sharp, central vision. You need central vision to see objects clearly and to do tasks such as reading and driving.

AMD affects the macula, the part of the eye that allows you to see fine detail. It does not hurt, but it causes cells in the macula to die. In some cases, AMD advances so slowly that people notice little change in their vision. In others, the disease progresses faster and may lead to a loss of vision in both eyes. Regular comprehensive eye exams can detect macular degeneration before the disease causes vision loss. Treatment can slow vision loss. It does not restore vision.

NIH: National Eye Institute
Definition (CSP) deterioration of the macula lutea in the retina; may be inherited, drug induced, or due to aging; leads to a severe loss of central vision while peripheral vision is retained.
Concepts Disease or Syndrome (T047)
SnomedCT 302891003, 422338006
English MACULA LUTEA DEGENERATION, MACULAR DEGENERATION, Macular degeneration, DEGENERATION MACULAR, Macular degeneration (disorder), Degenerative disorder of macula (disorder), Degenerative disorder of macula, Macular degeneration syndrome, macular degeneration of retina (diagnosis), macular degeneration of retina, macular degeneration (physical finding), macular degeneration, degeneration of macula, Macular Degeneration, Macula lutea degeneration, Retinal macula lutea degeneration, Macular luteal degeneration, Degeneration macular, macular degenerations, Degeneration;macular, degeneration macular, macula lutea degeneration, Macular degeneration of retina, unspecified
German MAKULADEGENERATION, Degeneration der Makula, retinale Macula lutea Degeneration, Macula lutea Degeneration, MAKULA LUTEA DEGENERATION, Maculadegeneration, Makuladegeneration
Italian Degenerazione maculare, Degenerazione della macula lutea retinica, Degenerazione della macula
Spanish trastorno degenerativo de la mácula (trastorno), trastorno degenerativo de la mácula, Degeneración de la mácula lútea, Degeneración de la mancha amarilla de la retina, degeneración macular (trastorno), degeneración macular, Degeneracion macular, MACULA LUTEA, DEGENERACION, Degeneración macular
Dutch macula lutea retina degeneratie, degeneratie macula, macula lutea degeneratie, Macula degeneratie, Maculadegeneratie, macula degeneratie
French Dégénérescence de la tache jaune rétinienne, Dégénérescence maculaire lutéale, Dégénérescence de la macula lutea, DEGENERESCENCE DE LA MACULA LUTEA, DEGENERESCENCE MACULAIRE, Degenerescence maculaire, Dégénérescence maculaire
Portuguese Degenerescência da mácula lútea, Degenerescência da mácula lútea retiniana, DEGENERESCENCIA DA MACULA LUTEA, DEGENERESCENCIA MACULAR, Degenerescencia macular, Degenerescência macular
Japanese 網膜黄斑変性, 黄斑変性, ﾓｳﾏｸｵｳﾊﾝﾍﾝｾｲ, ｵｳﾊﾝﾍﾝｾｲ
Swedish DEGENERATION AV MACULA
Finnish MAKULADEGENERAATIO, TARKAN NAON ALUEEN RAPPEUMA
Norwegian MAKULADEGENERASJON
Danish Makula-degeneration
Hungarian macula-degeneracio, Macula lutea degeneratio, Macula degeneratio
Czech Makulární degenerace, Degenerace sítnice v místě macula lutea, Degenerace macula lutea, Degenerace makula lutea
Basque ORBAINAREN ENDAKATZEA
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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