Case Study

Age-Related Macular Degeneration (ARMD)

Obedoza, Ruzzell P.
103-A

Ms. Lea Aquino

Clinical Instructor
Ospital Ng Makati
I. Patient’s Profile

Name: Mr. XYZ

Age: 71 years old
Sex: Male
Status: Widow
Address: #972 Sulu Pitigo, Makati Philippines
Nationality: Filipino Religion: Roman Catholic
Occupation: None
Contact No.: 0921783557
Diagnosis: Age-Related Macular Degeneration (OD) – Wet Type
Physical Findings: Pigmentation “in” the centre of the macula
To consider: Nuclear Scleroris (OD)
Chief Complaint: “Sumasakit ang ulo ko at pag sumasakit, nanlalabo etong kanang mata ko.”

II. Patients History

History of Present Illness

Patient is attending the Ophthalmology Department at Ospital ng Makati and had undergone
many tests like fluorescein angiography.
 2 months PTC
 Patient is noted with teary eye and stinging
 Negative (-) for foreign body (FB)sensation
 Positive (+) for blurring of vision (BOV)
 Diagnosed with astigmatism

Past Medical History:

(-) Hypertension – The client has a history of hypertension for the past 20 years and is taking
Felidipine for maintainance

Family History:
(-) Asthma
(-) Hypertension – his siblings exhibits HPN
   

   
III. Physical Assessment

General Appearance

Observations
 Conscious, oriented in time, she is cooperative and used appropriate language
 Stature is big, appropriate in dress, no body odor, no physical deformity

Skin
 Light brown, warm and smooth, no lesions, she has molds

Head and Face

 No presence of lesion, hair is fairly distributed , head is round and symmetrical

Eyes
 Abnormal visual acuity
OD – 20/200
OS – 20/30

Ears
 There’s no ear problem

Nose
 Appropriate in size and shape

Neck
 No lesions noted, appropriate in size and shape

Breast
 Normal in size

Chest/Lungs
 No retractions

Abdomen
 No lesions

Extremities
 Complete fingers and nails in upper extremities
 Complete toes and nails in lower extremities

Nails
 Smooth nail texture, pink in color
IV. Anatomy and Physiology (Macula)

The macula or macula lutea (from Latin macula, "spot" + lutea, "yellow") is an oval-shaped
highly pigmented yellow spot near the center of the retina of the human eye. It has a diameter of
around 5 mm and is often histologically defined as having two or more layers of ganglion cells. Near
its center is the fovea, a small pit that contains the largest concentration of cone cells in the eye and
is responsible for central vision, and also contains the parafovea and perifovea.
Because the macula is yellow in colour it absorbs excess blue and ultraviolet light that enter the eye,
and acts as a natural sunblock or sunglasses for this area of the retina. The yellow colour comes
from its content of lutein and zeaxanthin, which are yellow xanthophylls carotenoids, derived from
the diet. There is some evidence that these carotenoids protect the pigmented region from some
types of macular degeneration.

Structures in the macula are specialized for high acuity vision. Within the macula are the fovea
and foveola which contain a high density of cones (photoreceptors with high acuity).

Whereas loss of peripheral vision may go unnoticed for some time, damage to the macula will
result in loss of central vision, which is usually immediately obvious. The progressive destruction of
the macula is a disease known as macular degeneration and can sometimes lead to the creation of a
macular hole. Macular holes are rarely caused by trauma, but if a severe blow is delivered it can
burst the blood vessels going to the macula, destroying it.

Visual input to the macula occupies a substantial portion of the brain's visual capacity. As a
result, some forms of visual field loss can occur without involving the macula; this is termed macular
sparing.