Classification of AMD
Dry AMD (dAMD)
- Early AMD
- Multiple small drusen > 63 μm
- A few medium-sized drusen 63–125 μm
- Intermediate AMD
- At least 1 large druse > 125 μm
- > 20 medium-sized drusen
- Advanced AMD with geographic atrophy (GA)
Wet AMD (wAMD)
Advanced AMD with choroidal neovascularization (CNV)
History
Decreased visual acuity, metamorphopsia, family history, smoking, systemic diseases
Differential diagnosis
Hereditary drusen maculopathy, vitelliform maculopathy, central serous chorioretinopathy, polypoidal choroidal vasculopathy (PCV), secondary CNV
Examination
- OCT M P and photographs (scanning laser ophthalmoscopy (infrared laser)) OU
- Fundus photographs > documentation of hemorrhages
- Subjective refraction
- Spectacle correction adjustment if needed
- Amsler grid
- Applanation tonometry and optic disc assessment
- Anterior segment
- Detailed fundoscopy
Treatment
dAMD
- Smoking cessation
- Cardiovascular risk factors
- Nutritional supplementation (AREDS-2)
- Vitamin C 500 mg, vitamin E 400 IU, zinc 80 mg, copper 2 mg, lutein 10 mg, zeaxanthin 2 mg
- Preparations: PreserVision tablets 2x/day, Protina Trophosan Visiobalance 2x2/day, Orthomol AMD extra tablets 2x2, Vitalux plus 2x/day
- Indication: 50–85 years with bilateral intermediate AMD or advanced AMD in one eye
- Low-vision counseling
- Patient education on "age-related macular degeneration"
wAMD:
Follow-up
- Self-monitoring with the Amsler grid (daily) > Prompt presentation if changes occur
- Early dAMD: 12 months with OCT M P and photographs
- Intermediate AMD: 6 months with OCT MP and photographs
- Advanced AMD: 6 months with OCT M P and photographs
Prognosis
In wAMD with CNV, 10–12% risk of CNV in the fellow eye
Sources: Eyewiki.org, Blaubuch Inselspital Bern, Will's Eye Manual
