Wet Age-Related Macular Degeneration (Wet ARMD)

Wet Age-Related Macular Degeneration (Wet ARMD)
SYMPTOMS Rapid central vision loss, Metamorphopsia
SIGNS Choroidal neovascular membranes, Fibrovascular RPE detachments, Serous RPE detachments, Hemorrhagic RPE detachments, RPE tear, Cystoid macular edema
Signs of dry age-related macular degeneration may also be present including an Absent foveal reflex, RPE mottling, Drusen, Geographic atrophy
WORK-UP Color vision, Full eye exam with dilated retinal exam, OCT analysis of the macula, OCT-Angiography, Fundus Autofluorescence, Fluorescein Angiography, Indocyanine Green Angiography, Fundus photos, Infrared retinal imaging, Watzke-Allen test, Macular photostress test, Amsler grid, Macular pigment optical density, Preferential hyperacuity perimetry, Genetic testing (determines potential rate of progression and type of treatment), Dark adaptation, Microperimetry
TREATMENT Refer to retinal specialist ASAP for anti-VEGF treatment
Lifestyle changes (Discontinue smoking, Diet rich in fruits and vegetables, Exercise, Control blood pressure)
Wear UV protection
Give take home Amsler grid in order to monitor for change
Begin AREDS II vitamins (may need an alternative if patient has an adverse reaction to zinc based on genetic testing)
Low vision devices
FOLLOW-UP If wet ARMD is only in one eye and stable (after treatment with retinal specialist), patient should be seen in 3-4 months
If wet ARMD is in both eyes and stable (after treatment with retinal specialist), patient should be seen in 6 months
ETIOLOGY Decrease in permeability of Bruch’s membrane and damage to the RPE leads to a decrease in oxygen and nutrients to the outer retina and subsequent activation of angiogenesis
DIFFERENTIAL DX Dry Age-Related Macular Degeneration, Pattern dystrophy, Drug induced maculopathy, Polypoidal choroidal vasculopathy
NOTES There are 4 types of choroidal neovascular membranes: Occult (Type 1), Classic (Type 2), Retinal angiomatous proliferation (Type 3), Mixed (Type 4)
Eventually will develop into cicatricial ARMD (involves disciform scarring and involuted choroidal neovascular membranes)
Wet Age-Related Macular Degeneration (Wet ARMD): OCT of the macula demonstrating a choroidal neovascular membrane with adjacent subretinal fluid https://timothyjackson.london/patients/age-related-macular-degeneration/