Age-related Macular

Degeneration
Definition

Age-related macular degeneration (AMD) is a degenerative disorder

affecting the macula, characterized by the presence of specific clinical
findings, including drusen and retinal pigment epithelium (RPE)
changes, in the absence of another disorder.
Drusen

• Drusen are extracellular deposits located at the interface between the

RPE and Bruch membrane, composed of a broad range of
constituents derived from immune-mediated and metabolic
processes in the RPE.
Classification

1. Conventional classification
2. Clinical classification
Conventional Classification

1. Dry AMD
2. Wet AMD
Dry AMD
Wet AMD
Clinical Classification
Risk Factors
• Age
• Race
• Hereditary--- CFH gene and ARMS2 gene
• Smoking
• Hypertension
• Diet--- high fat intake increases risk
• Aspirin--- increases risk
• Others--- cataract surgery
Differential Diagnosis

• Doyne honeycomb retinal dystrophy

• Cuticular drusen
• Type 2 membranoproliferative glomerulonephritis
Investigation
• Optical coherence tomography (OCT)
• Fundus fluorescein angiography (FFA)
• Indocyanine green angiography (ICGA)
• Optical coherence tomograph angiography (OCT-A)
OCT showing geographic atrophy and drusen
FFA showing hypofluorescence due to subretinal hemorrhage and
hyperfluorescence due to leaky CNV
Treatment

1. Antioxidant supplements

• Vitamin E (400 IU)

• Vitamin C (500 mg)
• Lutein (10 mg)
• Zeaxanthin (2 mg)
• Zinc (25–80 mg)
• Copper (2 mg)
Treatment
2. Intravitreal anti-vascular endothelial growth factor (VEGF)
3. Photodynamic therapy (PDT)
4. Combine therapy (anti-VEGF and PDT)
Thank You