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Therapeutics IV: Exam #4 - Macular Degeneration
n/a
17
Health Care
Graduate
11/13/2010

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Term
Macular Degeneration
Definition
deterioration of macula resulting in loss of central vision & high-resolution visual acuity;
leading cause of severe, irreversible vision impairment
Term
Definitive Risk Factors for Macular Degeneration
Definition
age;
light pigmentation (white ethnicity);
cigaretter smoking;
family history
Term
Potential Risk Factors for Macular Degeneration
Definition
cardiovascular dx, HTN, low dietary intake of antioxidant vitamins or Zn, increased BMI, high dietary fat intake
Term
Dry AMD
Definition
formation of drusen;
retinal pigment abnormalities: atrophy of retinal pigment epithelium or pigmentary clumping;
Term
Wet AMD
Definition
advanced, worse prognosis;
neovasularization in macula: abnormal growth of blood vessels in subretinal space, vessels leak --> subretinal fluid &/or bleeding beneath the retina
Term
Early AMD
Definition
small or intermediate drusen & minimal macular pigment abnormalities;
usually normal central vision
Term
Intermediate AMD
Definition
medium or large drusen in 1 or both eyes;
18% of pts will progress to advaned w/in 5 yrs
Term
Non-neovascular Advanced (Dry) AMD
Definition
atrophy of retina & other layers of macula
Term
neovascular (Wet) AMD
Definition
new blood vessels
Term
Symptoms of Macular Degeneration
Definition
mild blurry central vision;
difficulty reading;
trouble w/ color & contrast;
painless, progressive, moderate to severe blurring of central vision;
sudden loss or distortion of vision possible
Term
Ophthalmologic Exam
Definition
drusen visible on dilated exam;
patches on geographic atrophy or increased pigmentation;
subretinal fluid and/or hemorrhage in wet AMD
Term
Treatment Goals for Macular Degeneration
Definition
slow disease progression;
maintain QOL;
minimize adverse effects
Term
Dry AMD
Definition
no approved pharmacologic therapy for this type of AMD
Term
Antioxidant supplementation - ascorbic acid 500 mg, vitamin E 400 IU, beta-carotene 15 mg, zinc oxide 80 mg, cupric oxide 2 mg
Definition
used in Age-Related Eye Disease Study;
reduced rate of clinical progression of all types of AMD by 28% in pts w/ intermediate AMD;
recommended in pts w/
Term
Vascular Endothelial Growth Factor (VEGF) Antagonists - pegaptanib (Macugen), ranizumab (Lucentis), bevacizumab (Avastin)
Definition
MoA: binds to growth factors to suppress neovascularization;
Dose: prefilled intravitreal injections once monthly;
Side Effects:
Local - inflammation, blurred vision, conjunctival hemorrhage, pain, vitreous floaters;
Systemic - HTN, HA, possible increase in stroke;
C/Is: ocular infection;
Term
Non-Pharm Treatment for Dry AMD
Definition
stop smoking;
laser drusen ablation - role is unclear
Term
Non-Pharm Treatment of Wet AMD
Definition
Thermal laser photooagulation - high intensity laser coagulates abnormal choroidal neovascular membranes;
Photodynamic therapy - locally damages neovascular endothelium, reduces risk of visual acuity loss & legal blindness over 1-2 yrs, requires multiple treatments, SE: severe photosensitivity;
Surgery & radiation -> significant risks, little to no benefit
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