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Clinical Summary

Age-related macular degeneration increases in incidence with each decade over 50 and is evidenced by accumulation of either hard drusen (small, discrete, round, punctate nodules) or soft drusen (larger, pale yellow or gray, without discrete margins that may be confluent). Most patients with drusen have good vision, although there may be decreased visual acuity and distortion of vision. There may be associated pigmentary changes and atrophy of the retina. Vision may slowly deteriorate if atrophy occurs.

Patients with early or late degenerative changes of the macula are at risk of developing choroidal neovascularization (CNV), which is associated with distortion of vision, blind spots, and decreased visual acuity. Macular appearance may show dirty gray lesions, hemorrhage, retinal elevation, and exudation.

Management and Disposition

Patients with drusen need ophthalmologic evaluation every 6 to 12 months or sooner if visual distortion or decreasing visual acuity develops. If a patient complains of deterioration of visual acuity or image distortion, prompt ophthalmic evaluation is warranted.

FIGURE 3.2

Age-Related Macular Degeneration, Drusen. Typical macular drusen and retinal pigment epithelial (RPE) atrophy (scalloped pigment loss) in age-related macular degeneration. (Photo contributor: Richard E. Wyszynski, MD.)

Pearls

  1. Age-related macular degeneration is the leading cause of blindness in the United States in patients older than age 65 years.

  2. Patient may have normal peripheral vision.

  3. Untreated CNV can lead to visual loss within a few days.

  4. Patients frequently complain of distortion with CNV.

FIGURE 3.3

Age-Related Macular Degeneration, Drusen. Drusen are clustered in the center of the macula. (Photo contributor: Richard E. Wyszynski, MD.)

FIGURE 3.4

Age-Related Macular Degeneration. Hemorrhage seen beneath the retina in association with subretinal neovascularization. Note the retinal vessels are superficial to the hemorrhage, which lies just beneath the retina. (Photo contributor: Richard E. Wyszynski, MD.)

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