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AMD
Ocular Disease III Exam 2
104
Medical
Graduate
03/09/2013

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Cards

Term
3 factors that contribute to AMD damage
Definition
Oxidative Stress, Inflammation, Metabolic end product deposition
Term
4 layers/parts of the posterior pole primarily affected by AMD
Definition
RPE
Bruch's
Choriocapillaris
Photoreceptors
Term
What is the #1 cause of blindness in the US on people over 60
Definition
AMD
Term
Name 5 non-modifiable risk factors for AMD
Definition
Age Gender Race Ocular Pigmentation Heredity
Term
Which gender tends to be more affected by AMD
Definition
Females>Males
Term
Which race is commonly most affected by AMD
Definition
Caucasians
Term
Describe ocular pigmentation that increases risk for AMD
Definition
lighter pigmentation is at higher risk than darker-pigmented individuals
Term
Modifiable risk factors of AMD
Definition
Smoking
Cataract surgery
Phototoxicity
Obesity
HTN/Heart Dz
Alcohol
Daily aspirin use
Term
2 pigments that contribute to the natural coloration of the macula
Definition
Lutein
Zeaxanthin
Term
What structure provides nutrients to the Foveal Avascular Zone
Definition
Choriocapillaris
Term
3 Clinical Presentations of Early/Intermediate AMD
Definition
RPE hyperplasia/hypertrophy
Drusen
PED
Term
Clinical Presentation of Advanced Dry AMD
Definition
Geographic Atrophy
Term
Clinical Presentation of Advanced Wet AMD
Definition
CNV
Detachment
Vitreous hemorrhage
Disciform scarring
Term
What type of RPE pigmentation increases risk of CNV
Definition
Hyperpigmentation
Term
Fluorescein angiography in AMD-relate RPE pigmentation with fluorescence
Definition
Pigment clumping-->hypo
hypopigmentation -->Hyperfluorescence
Term
What is the autofluorescent component of lipofuscin triggered by light exposure
Definition
A2E
Term
Where in the retina is drusen found
Definition
Between BM of RPE and inner collagenous zone of Bruch's
Term
These substances make up what material found in diseased retina
Proteins, Vitronectin, Amyloid, Inflammatory components & Immunoligcal products
Definition
Drusen
Term
Drusen accumulation is thought to be due to what process
Definition
Inflammation in the subretinal space
Term
How does the presence of drusen affect the chance of developing macular abnormalities
Definition
80% chance
Term
4 types of drusen
Definition
Large Soft
Small Hard
Familial
Calcific
Term
Small Hard vs. Large Soft Drusen: size in relation to BV
Definition
Small=half a vein width
Intermediate=smaller than full width
Large=size of large vein at disc margin
Term
Small Hard vs. Large Soft Drusen: Borders
Definition
Small=well-defined
Large= fluffy, indistinct
Term
Small Hard vs. Large Soft Drusen: AMD diagnosis
Definition
Small-NOT enough to make diagnosis
Intermediate-enough for diagnosis
Large Soft=enough to make AMD diagnosis!!
Term
Small Hard vs. Large Soft Drusen: association with RPE dysfunction
Definition
Small=FOCAL dysfunction
Large=DIFFUSE dysfunction
Term
Large Soft Drusen may appear to similar to what other retinal problem
Definition
Clinically identical to RPE detachments
Term
Coalescence of Large Soft Drusen can cause what other retinal problem
Definition
PED (RPE detachment)
Term
FA of Soft Drusen: 2 factors that contribute to the degree of fluorescence
Definition

1. Quantity of pigment in RPE

2.Lipid content

Term
Which type of drusen: bilateral, elongated and radiating
Definition
Familial Drusen
Term
Symptoms of Familial Drusen and when they occur
Definition
20-30 yo, decreased VA, metamorphopsia, paracentral scotoma
Term
DDX between calcific drusen and hard exudates?
Definition
Based on level in the retina
Drusen=Deep
Exudates= Superficial
Term
Term for long standing drusen that leave patches of atrophy and deposits
Definition
Calcific Drusen
Term
Sharply demarcated, smooth, dome-shaped, elevations of RPE
Definition
PED
Term
What may result from a collapsed, non-resolved PED
Definition
Geographic Atrophy, CNV
Term
Appearance of FA of a PED
Definition
gradual, uniform staining of sub-RPE
Term
Visual symptoms of PED
Definition
Reduced VA
Metamorphopsia
Term
3 names for non-exudative AMD
Definition
Dry
Atrophic
Non-neovascular
Term
What proportion of Nonexudative AMD progresses to wet
Definition
10-20%
Term
What proportion of late stage AMD is wet/exudative
Definition
80.00000%
Term
True or False Dry AMD is accompanied by CNV and sub-retinal exudates
Definition
False
Term
Vision loss due to Nonexudative AMD is most noticable in what conditions
Definition
Near tasks, night vision
Term
Visual symptoms of intermediate dry AMD
Definition
blurred vision/blind spot
Metamorphopsia
Reduced contrast sensitivity
Term
Geographic Atrophy is characterized by gradual loss in these 3 structures
Definition
RPE
Choriocapillaris
Photoreceptor function
Term
Geographic Atrophy results in what changes regarding the Outer Nuclear Layer
Definition
It comes to rest directly on the basement membrane of the RPE
Term
How does the Outer plexiform layer change due to Geographic Atrophy
Definition
Becomes thinned and vacuoled
Term
Geographic atrophy accounts for _____________ of visual morbidity in AMD
Definition
20.00000%
Term
Vision loss due to geographic atrophy is most noticed during what type of visual activities
Definition
Near work
Term
2 objective findings associated with geographic atrophy
Definition
Choroidal atrophy
Large choroidal vessels become more prominent
Term
Approx Follow up time for Geographic Atrophy
Definition
6-12 months depending on severity/extent
Term
What is the HALLMARK of exudative AMD
Definition
Choroidal neovascularization
Term
How does CNV cause detachment of the RPE or sensory retina
Definition
The new vessels leak fluid that detaches the layers
Term
Leakage in Exudative AMD can lead to 4 complications
Definition
Serous detachment of RPE
Lipid exudation
Hemorrhage
RPE tears
Term
3 subjective visual complaints associated with CNV
Definition
Distorted vision
Reduced Vision
Color distortion
Term
Pt presents with visual complaints consistent with CNV, name 3 things you should do
Definition
Dilate
OCT
refer for FA STAT
Term
You see these 4 things
Gray green membrane
Sensory retinal detachment
subretinal/sub-RPE hemorrhage
Hard exudates
What is this?
Definition
CNV
Term
How does acuity at time of diagnosis relate to prognosis of AMD
Definition
The worse the acuity the worse the prognosis
Term
Name a new technology used to monitor progression of AMD
Definition
Preferential Hyperacuity Perimeter
Term
Advantage of PHP over AG
Definition
much more sensitive in detecting disease
Term
Disadvantage of PHP over AG
Definition
PHP has a higher rate of false positives
Term
3 types of CNV membranes on FA
Definition
Classic CNVM
Minimally classic CNVM
Occult CNVM
Term
Which type of CNVM is most common
Definition
Occult
Term
Which type of CNVM has a well defined membrane
Definition
Classic
Term
Which type of CNVM fills with dye in a lacy pattern
Definition
Classic
Term
Which type of CNVM has a poorly defined membrane and less precise features
Definition
Occult
Term
2 methods to confirm diagnosis of CNVM
Definition
OCT
FA is a must to determine treatment
Term
Name 5 serious complications of CNV
Definition
Hemorrhagic RPE Detachment
Hemorrhagic sensory detachment
Vitreous hemorrhage
Disciform scarring
Massive exudation
Term
FA of a hemorrhagic RPE detachment will show HYPERfluorecence corresponding to the ___________________
and hypofluorescence corresponding to the ____________________
Definition
Hyper=RPE detachment
HYPO=hemorrhage
Term
Differentiate the color difference in hemorrhagic RPE detachment vs. hemorrhagic sensory
Definition
RPE is very dark red, sensoryis a BRIGHT red
Term
FA of hemorrhagic sensory detachment
Definition
Will show HYPOfluorescence due to blockage of choroidal fluorescence
Term
Vitamin E
Vitamin C
Beta-carotene
These substances all have what in common
Definition
Are all Antioxidants
Term
Name 2 macular pigments thought to reduce risk/severity of AMD
Definition
Lutein and Zeaxanthin
Term
AREDS2 study-looking at the effects of higher doses of which 3 substances
Definition
lutein, zeaxanthin an domega-3 fatty acids
Term
AREDS2 study-looking at the effects of removing which substance from the original formula
Definition
Beta-carotene
Term
AREDS2 study-looking at the effects of reducing the amount of which substance in the formula
Definition
Zinc
Term
6 lifestyle choices we can educate our patients about to reduce AMD
Definition
UV400 protection
balanced diet/green leafy vegetables
antioxidants
exercise
HTN control
Quitting smoking
Term
DDX of Hard exudates vs. Drusen-difference in location in retina?
Definition
Hard exudates=between IPL and INL
Drusen=RPE
Term
Name 3 vascular diseases associated with Cotton wool spots
Definition
AIDS
DR
HTN retinopathy
Term
Name 4 'diseases' associated with hard exudates
Definition
DR
HTN retinopathy
Coat's dz
CNV
Term
What is Macula Risk (ArcticDx)?
Definition
Commercial genetic test (cheek swab) that measures inheritable risk factors for AMD
Term
What did the AREDS study research?
Definition
how vitamin and mineral supplements affect the progression of AMD
Term
Result of study on use of fenretinide to treat GA
Definition
slows down damage from A2E and lipofuscin, also reduced the rate of conversion to CNV by 2 fold
Term
2 forms of destructive therapy for wet AMD
Definition
Laser photocoagulation
Photodynamic therapy
Term
Which levels of progression of AMD had the best results in the Macular Photocoagulation Study
Definition
Those with smaller lesions and worse initial Vas had better and earlier results
Term
How did the TAP study (tx of AMD with PDT) find PDT affected baseline VAs
Definition
It was found to preserve baseline VA whereas those who were untreated were found to have worse Vas after 2 years
Term
PDT seems to work best for which type of CNV according to recent studies
Definition
Classic CNV
Term
Name 4 available VEGF inhibitors
Definition
Macugen
Lucentis
Avastin
Eylea
Term
Name 3 complications due to Macugen (anti-VEGF) injection
Definition
Endophthalmitis
Traumatic cataract
RD
Term
According to the presented studies, how does Macugen affect AMD
Definition
delays the progression of AMD, pts still get worse just not as quickly as thoe untreated
Term
Of the 4 anti-VEGF meds, which does not bind to ALL forms of VEGF
Definition
Macugen
Term
Name 6 ocular complications due to Lucentis
Definition
Conj hemes
eye pain
vitreal floaters
increased IOP
Endophthalmitis
Cataracts
Term
In the ANCHOR study, which had better results, Lucentis or PDT
Definition
Lucentis
Term
When did VA improvement peak in studies on Lucentis
Definition
at 4 months and then it plateaued
Term
What is Avastin FDA approved to treat?
Definition
Colon cancer
Term
General results of the CATT study (Lucentis vs. Avastin) regarding central retinal thickness
Definition
Decrease in thickness was greater with Lucentis monthly than any other group
Term
General results of the CATT study (Lucentis vs. Avastin) regarding serious systemic effects
Definition
Proportion of serious systemic effects was higher with Avastin than with Lucentis
Term
How does the cost of monthly injections of Lucentis vs. Avastin compare
Definition
Lucentis monthy=$24 000
Avastin Monthly- $600
Term
Which anti-VEGF has the longest duration
Definition
Eylea
Term
Recommended dosage for Eylea
Definition
1X/month for 3 month then every other month
Term
What are tip cells
Definition
naked endo cells at the edge of the neo complex that lead the expansion of the membrane.
They produce a substance that recruits pericytes which then act as a barrier to anti-VEGF monotherapy
Term
What substance do Tip cells produce
Definition
Platelet Derived Growth Factor
Term
Why must anti-VEGF tx be continued forever
Definition
Only the tip cells are killed, thus expansion is inhibited but the remainder of the membrane is unaffected. It will expand once therapy stops
Term
What substance does Fovista inhibit?
Definition

PDGF

It is anti-PDGF

Term
What were the results of treating AMD patients with both Lucentis and Fovista
Definition
62% additional benefit, ie. more letters gained with combo tx compared to monotherapy
Term
How does treatment with triamcinolone affect progression of neo
Definition
decreases vascular permeability and decreases VEGF
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