Age-related%20macular%20degeneration Signs and Symptoms

Signs and Symptoms

Introduction

The macular disorder may have one or more of the following:
- Formation of drusen which are localized deposits of extracellular material usually concentrated in the macula
- Abnormalities in the retinal pigment epithelium (eg hypopigmentation or hyperpigmentation)
- Retinal pigment epithelium (RPE) and choriocapillaris geographic atrophy
- Neovascular (exudative) maculopathy
- Choroidal neovascularization (CNV), polypoidal choroidal vasculopathy (PCV), reticular pseudodrusen, or retinal angiomatous proliferation
Leading cause of irreversible vision loss especially in the elderly
Decreased central vision and distortion of seeing straight lines (metamorphopsia) are the most common symptoms of age-related macular degeneration (AMD)

Definition

Chronic, progressive, degenerative disease that occurs in the pigment, neural and vascular layers of the macula that causes central vision loss

Signs and Symptoms

Early stage manifestations:
- Decline of reading ability in dim light
- Glare difficulty
- Dark and light adaptation difficulty (eg the patient wakes up at night and unable to read the clock because of seeing central dark patch in the visual field that disappears within a few minutes as the eye adapts)
- Needs to use magnifiers and bright light to be able to see as well as the patient used to
- Gradual progressive central vision loss
Late stage manifestations:
- Metamorphopsia or the patient complains that straight line appearing crooked or wavy that can be confirmed by using Amsler grid
- Difficulty in reading small sizes of print and then later with larger print and/or words
- Profound and rapid central vision loss

Risk Factors

Increasing age (>50 years old)
Genetic factors (eg complement factor H genes)
Family history of AMD
Cigarette smoking history of >20 years
- Current smokers have 2- to 3-fold risk and there is a dose-relationship with pack years of smoking
Hypertension
Diet (eg low intake of antioxidants and zinc, high total fat and trans-fat)
Obesity
Presence of AMD in the other eye
Race
- While Caucasians are at increased risk compared to African or Hispanic descent, studies fail to show consistent differences in risk between Caucasians and Asians
Gender
- Studies have consistently shown women to be at increased risk

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