Dry Age-related Macular Degeneration

  • Aging degeneration of the retinal pigment epithelium in fovea
  • Most common cause of persistent vision loss in elderly adults in advanced industrial countries
  • Cause unknown
  • Smoking may accelerate progression
  • Oral intake of special combination of vitamins slows progression in some cases
  • Refer non-urgently if this is incidental finding
  • Refer urgently if the patient has new vision loss
  • Over time, drusen often increase (Watch this typical sequence)
  • In worst cases, large areas of retinal atrophy appear and visual acuity declines
  • For dry age-related macular degeneration with large drusen, combination of vitamin C 500mg, vitamin E 400 IU, zinc oxide 80mg, cupric oxide 2mg, lutein 10mg, and zeaxanthin 2mg reduces progression of vision loss
  • Smokers will be advised to quit
  • Patients will be advised to test themselves periodically with Snellen near vision card and Amsler grid to detect drop in vision or perceived distortion of grid lines ("metamorphopsia"), which might signal that...
  • New blood vessels have grown from choroid into submacular retina ("subretinal neovascularization"), which has led to...
  • Bleeding under the retina that further blurs and distorts vision (Wet age-related macular degeneration)
  • Periodic injections of vascular endothelial growth factor (VEGF) inhbitors into vitreous cavity (yes, really!) slow and sometimes reverse vision loss caused by exudate and bleeding into fovea