AMD

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WHAT IS AGE-RELATED MACULAR DEGENERATION (AMD)?


Age Related Macular Degeneration is a degenerative disease affecting the central part of retina called macula. The macula is responsible for sharp and central vision. The central vision: precise vision involved in reading, writing, recognition of details and of colours.

AMD is the third cause of legal blindness worldwide and the first one in industrialized countries. It affects more specifically people over 50 years old.

There are two forms of AMD, the atrophic one most commonly called the “dry form” and the exudative one also called the “wet form”. Both forms are generally progressive, not painful and develop in both eyes.

In early stages, AMD does not affect vision. Later, if the disease progresses, people experience wavy or blurred vision, and, if the condition continues to worsen, central vision may be completely lost.


Dry macular degeneration symptoms include:

  • Decrease in sensitivity to contrasts: Need to have better lighting for reading or for any precision work.

  • Decrease in visual acuity and increased blurring of central vision: Alteration of the perception of colours and Distortion of straight lines (which appear deformed and bowed).

  • Occurrence of a central dark spot in late phase (scotoma): Difficulty in recognizing faces, driving, reading or performing other activities of daily life.

  • Generally bilateral symptoms
  • Diagnosis established by an ophthalmologist
  • Examination of the back of the eye. Macular degeneration is often associated with yellow depos-its that form under the retina called drusen. Fluid or blood or a mottled appearance are caused by drusen visible during this examination.
  • Test for defects in the center of vision. An Amsler grid may be used to test for defects in central vision. In case of macular degeneration, some of the straight lines in the grid will look faded, bro-ken or distorted.
  • Fluorescein angiography. Taken with a special camera after having injected a dye, fluorescein angiography highlights blood vessels in the eye and reveals the presence of leakage of abnormal blood vessels or retinal changes.
  • Indocyanine green angiography (ICG). Like fluorescein angiography, this test uses an injected dye. It is used to confirm the findings of a fluorescein angiography or to identify abnormal blood vessels deeper in the retina.
  • Optical coherence tomography. This non-invasive imaging test displays detailed cross sections of the retina. It identifies areas of thinning, thickening or swelling. This test is also used to help monitor how the retina responds to macular degeneration treatments.
  • Regular checks after the age of 50 are required especially in case of risks factors.

MANAGEMENT OF DRY FORM AMD (ATROPHIC)

  • To date, there is no curative treatment for atrophic AMD.
  • The utility of dietary supplementation with Zinc, Copper, Vitamin C and E and Lutein and with pro-vitamin A for patients with a progressive risk (dry or unilateral wet form)
  • Utility for concomitant measures:
    • Utility of objects with appropriate ergonomics and technologies of accessibility: lighted magnifying glasses, synthetic voice software, etc.
    • Rehabilitation for limited vision: All techniques designed to maximise the remaining vision.

MANAGEMENT OF WET FORM ADM (EXUDATIVE) 

  • The initiation of treatment with anti-VEGF as early as possible after diagnosis of retrofoveolar exudative AMD.
  • In case of contraindication to anti-VEGF, the following therapeutic alternatives can be considered on a case by case basis:
    • Photodynamic therapy with verteporfin;
    • Laser photocoagulation in case of choroidal neovascularization (CNV)