Mimickers of Age-Related Macular Degeneration

In the Western World, the leading cause of irreversible blindness is Age- Related Macular Degeneration (ARMD). It can have significant visual impairment, and it is important that the practicing ophthalmologist is knowledgeable in the diagnosis and treatment of ARMD. Equally important is knowledge in the diagnosis of other disease entities that may mimic ARMD, as this may change the prognosis, treatment and visual outcome of patients. This article discusses those diseases that mimic ARMD and their distinguishing features.     

Factors Influencing Visual Acuity Following Vitrectomy for Exudative Age-related Macular Degeneration

Purpose: We investigated the influence of various factors on visual results in patients undergoing surgical removal of choroidal neovascular membranes (CNVM) caused by age-related macular degeneration (AMD).Subjects and Methods: This study was performed in 55 eyes of 55 patients who underwent surgical removal of CNVM for AMD and followed them for 6 months or more. The criterion for surgical eligibility was active subfoveal choroidal neovascular membrane of 0.5 or more disc diameter above the retinal pigment epithelium with visual acuity of 0.3 or worse. We investigated the influence of various factors on the logarithm of the minimum angle of resolution (log MAR) final visual acuity. The factors were age, symptom duration, preoperative log MAR visual acuity, CNVM diameter, mean deviation with visual field analyzer, previous laser treatment, posterior vitreous detachment, findings of indocyanine green angiography, operative complications, and recurrence of CNVM.Results: Better preoperative visual acuity, shorter symptom duration, and smaller CNVM diameter were correlated with better postoperative final visual acuity.Conclusions: Surgical excision of subfoveal CNVM may be the better therapeutic choice in selected cases with AMD.     

Imaging in Neovascular Age-Related Macular Degeneration

Imaging plays an essential role in the diagnosis and treatment of age-related macular degeneration (AMD). This review describes the imaging modalities most commonly employed by ophthalmologists caring for patients with neovascular AMD. Imaging modalities discussed include fluorescein angiography, optical coherence tomography, indocyanine green angiography, and fundus autofluorescence.     

Nutritional Supplementation and Age-Related Macular Degeneration

The prevalence of Age-related macular degeneration (AMD) is increasing as the population of elderly in the United States grows. Currently the pathogenesis is not fully understood, however oxidative injury is felt to play a significant role. The Age-Related Eye Disease Study (AREDS) established that a supplemental combination of dietary antioxidants of zinc, β-carotene, vitamin C and vitamin E slowed progression of AMD. Recently lutein, zeaxanthin, B vitamins, and omega-3 fatty acids have also been reported to decrease AMD progression, while vitamin E and β-carotene where found to increase the risk of late AMD. AREDS2 is currently underway, further examining the effects of omega-3 fatty acids, carotenoids, and the original AREDS formulation. While awaiting the results of AREDS2, it is important to understand the evidence currently available, so that physicians can safely advise patients today. This review examines the most current literature available exploring nutritional supplementation in age-related macular degeneration.     

Risk Factors for Discontinuation of Treatment for Neovascular Age-Related Macular Degeneration

Purpose: To investigate risk factors for treatment discontinuation for neovascular age-related macular degeneration (nAMD).

Methods: Data from the Swedish Macula Register and the Skåne Healthcare Register are reported on the treatment received by 932 nAMD patients diagnosed 2013?2015. Treatment discontinuation is defined as having a termination visit or lacking a control or treatment visit during the period of 10?14 months after the diagnostic visit. The risk of treatment discontinuation during the first year is estimated using a Poisson model and a classification tree.

Results: 503 eyes (50.9%) discontinued the treatment within the first year. Patients with visual acuity below 60 ETDRS letters (20/60 Snellen) at baseline, serious comorbidities, or treated at the university hospital have a 42% (95% CI 25?61%, P < 0.001), 27% (95% CI 13?43%, P = 0.001) and 30% (95% CI 15?46%, P < 0.001) increased risk to discontinue treatment compared with similar patients. Patients on ranibizumab therapy have a 45% (95% CI 28?63%, P < 0.001) increased risk for treatment discontinuation during year 1 compared with patients on aflibercept therapy. The classification tree also shows that patients on ranibizumab therapy and those with low VA at baseline are at a higher risk of terminating treatment.

Conclusions: Almost half of the patients starting anti-VEGF therapy discontinue treatment during the first year. Patients with risk factors may require additional support to continue with the treatment. Aflibercept therapy could be an alternative to patients at risk of treatment discontinuation.     

Risk Factors for Progression of Early Age-Related Macular Degeneration in Koreans

Purpose: To identify risk factors for the progression of early age-related macular degeneration (AMD) in Koreans.

Methods: This study was conducted at a health-screening center and followed a prospective cohort study design. Of 10,890 participants older than 50 years, 318 (2.92%) presented with early AMD. Among these 318 participants, we re-examined 172 participants after a mean duration of 4.4 years. Progression was defined by the Age-Related Eye Disease Study (AREDS) simplified AMD severity scale. Multivariable logistic regression was used to examine associations between AMD progression and baseline physical, demographic, behavioral, and ocular characteristics.

Results: Of the 172 participants with early AMD who were re-examined, 34 (19.8%) had progression. Multivariable analyses revealed that current smoking (odds ratio, OR, 7.0, 95% confidence interval, CI, 1.4–34.4, adjusted for age, alcohol consumption, body mass index, BMI, blood pressure, BP, total cholesterol, and high density lipoprotein, HDL, cholesterol) and hypertension (OR 10.3, 95% CI 1.9–55.7, adjusted for age, smoking status, alcohol consumption, BMI, total cholesterol, and HDL cholesterol) were independently associated with progression of early AMD. Additionally, the presence of a central drusen lesion within one-third disc diameter of the macula (age-adjusted OR 4.8, 95% CI 1.3–17.6) and 20 or more drusen (age adjusted OR 7.8, 95% CI 2.5–24.0) were independently associated with progression of early AMD.

Conclusion: Current smoking, hypertension, central drusen location, and increasing number of drusen were associated with an increased risk of early AMD progression in Koreans.