History and exam

Key diagnostic factors

common

presence of risk factors

Key risk factors include older age, smoking, and positive family history.

sudden-onset blurring or distortion of vision

Often the first symptom of disease.

Can indicate development of choroidal neovascularisation with leakage of fluid in the macula.

drusen

A frequent feature in the early stages of disease.

Size and quantity differentiate between early stages of the disease (see Diagnostic criteria, Beckman classification of AMD).

macular pigmentary changes

Seen in intermediate AMD, along with drusen.

geographic atrophy

A form of late AMD.

Frequently associated with significant visual loss, especially if central macula (fovea) is involved.

choroidal neovascularisation

Presents with subretinal or intraretinal fluid, subretinal haemorrhage, retinal pigment epithelial detachment, retinal oedema, cysts, and/or lipid exudates.

A form of late AMD. If central macula (fovea) is affected, patient may have severe visual loss.

Other diagnostic factors

common

progressive loss of vision in one or both eyes

May occur in patients with choroidal neovascularisation or central geographic atrophy.

fibrovascular pigment epithelial detachment (neovascular AMD)

Presents as dome-shaped, fluid-filled irregular elevation of the neurosensory retina and retinal pigment epithelium. The choroidal neovascularisation is visible on optical coherence tomography as variable reflectivity under the elevated retinal pigment epithelium.

Commonly occurs as part of the clinical picture of neovascular AMD. Not seen in geographic atrophy.

fibrovascular scar formation

Typically an end-stage finding.

Scars may be disciform.

If foveal centre is affected, it almost universally results in severe visual loss.

reticular pseudodrusen

Small drusen-like deposits that form between the photoreceptors and retinal pigment epithelium. The reticular form has been particularly associated with progression to geographic atrophy, but pseudodrusen are also associated with progression to choroidal neovascularisation.

Risk factors

strong

increasing age

Incidence and prevalence of disease and associated features increase with age.[20]​​[21]

In the US in 2019, prevalence of early-stage AMD was 2% in people aged 40-44 years and 35% among people 85 years or older.[22]

smoking

One meta-analysis has shown that current cigarette smoking is strongly associated with late AMD.[9] Cessation of smoking may decrease risk.[9]

family history of disease

One meta-analysis has shown that family history is strongly associated with late AMD.[9] Polymorphisms associated with a number of genes have been shown to modify AMD risk, including the complement factor H locus, ARMS2/HTRA1, and C3.[13]

weak

previous cataract surgery

One meta-analysis has shown that previous cataract surgery is associated with late AMD.[13]

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