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Age-related macular degeneration - External and Internal Eye
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Age-related macular degeneration - External and Internal Eye

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Contributors: Rachel Ellis MD, Andrew Goodfriend MD, Lauren Patty Daskivich MD, MSHS, Brandon D. Ayres MD, Christopher Rapuano MD, Harvey A. Brown MD, Sunir J. Garg MD
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Synopsis

Age-related macular degeneration (AMD) is a degenerative disorder affecting people 50 and older that may impair central vision. AMD is now the leading cause of permanent blindness in the Western world. The incidence increases with age. The disease is more common in white individuals, females, and those with a positive family history of AMD. Obesity, smoking, hyperopia, light iris color, hypertension, high cholesterol, and cardiovascular disease are also contributing factors.

With age, the retinal pigment epithelium (RPE) accumulates waste products from the retina. Drusen, the hallmark of AMD, are focal deposits of this debris between the RPE and Bruch's membrane. Excess drusen can damage the RPE, leading to retinal atrophy and the expression of angiogenic cytokines. With choroidal neovascularization (CNV), choroidal vessels grow abnormally and leak or bleed into the subretinal space through defects in Bruch's membrane.

AMD can be divided into a non-neovascular (dry) atrophic type and an exudative neovascular (wet) type. The atrophic form comprises 90% of AMD and only 10% of blindness, while the exudative form makes up 10% of AMD but is responsible for 90% of vision loss.

Patients with early AMD are often asymptomatic. As the drusen cover more of the macula, patients may complain of fluctuating blurry vision or loss of contrast sensitivity. With exudative AMD, patients often note visual distortion or loss of vision.

Codes

ICD10CM:
H35.30 – Unspecified macular degeneration

SNOMEDCT:
267718000 – Age-Related Macular Degeneration

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Pattern dystrophy – in younger patients; lesion shows geographic shape. 
  • Central serous chorioretinopathy – in younger individuals (usually 40-60 years of age); no drusen. 
  • Ocular histoplasmosis syndrome – associated with CNV. 
  • Pathologic myopia – associated with CNV. 
  • Choroidal ruptures – associated with CNV. 
  • Angioid streaks – associated with CNV. 
  • Best disease – round or oval lesions may show different stages. 
  • Adult foveomacular dystrophy – yellow/green subfoveal lesion; may simulate CNV on fluorescein angiography. 
  • Intraretinal lipid (hard exudates) – may look like drusen. 
  • Cotton wool spots – may look like drusen. 
  • Retinal vascular occlusion (eg, central retinal vein occlusion) – associated with retinal hemorrhage. 
  • Diabetic retinopathy – associated with retinal hemorrhage. 
  • Drug toxicity – macula may appear mottled. 

Best Tests

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Management Pearls

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Therapy

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References

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Last Updated: 07/24/2013
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Age-related macular degeneration - External and Internal Eye
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Age-related macular degeneration : Blurred vision, Bilateral, Macular atrophy, Retinal hemorrhage, Retinal pigment clumping, Vision loss, Visual field defect, Retinal lipid deposits
Clinical image of Age-related macular degeneration
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