Term
| 3 factors that contribute to AMD damage |
|
Definition
| Oxidative Stress, Inflammation, Metabolic end product deposition |
|
|
Term
| 4 layers/parts of the posterior pole primarily affected by AMD |
|
Definition
RPE
Bruch's
Choriocapillaris
Photoreceptors |
|
|
Term
| What is the #1 cause of blindness in the US on people over 60 |
|
Definition
|
|
Term
| Name 5 non-modifiable risk factors for AMD |
|
Definition
| Age Gender Race Ocular Pigmentation Heredity |
|
|
Term
| Which gender tends to be more affected by AMD |
|
Definition
|
|
Term
| Which race is commonly most affected by AMD |
|
Definition
|
|
Term
| Describe ocular pigmentation that increases risk for AMD |
|
Definition
| lighter pigmentation is at higher risk than darker-pigmented individuals |
|
|
Term
| Modifiable risk factors of AMD |
|
Definition
Smoking
Cataract surgery
Phototoxicity
Obesity
HTN/Heart Dz
Alcohol
Daily aspirin use |
|
|
Term
| 2 pigments that contribute to the natural coloration of the macula |
|
Definition
|
|
Term
| What structure provides nutrients to the Foveal Avascular Zone |
|
Definition
|
|
Term
| 3 Clinical Presentations of Early/Intermediate AMD |
|
Definition
RPE hyperplasia/hypertrophy
Drusen
PED |
|
|
Term
| Clinical Presentation of Advanced Dry AMD |
|
Definition
|
|
Term
| Clinical Presentation of Advanced Wet AMD |
|
Definition
CNV
Detachment
Vitreous hemorrhage
Disciform scarring |
|
|
Term
| What type of RPE pigmentation increases risk of CNV |
|
Definition
|
|
Term
| Fluorescein angiography in AMD-relate RPE pigmentation with fluorescence |
|
Definition
Pigment clumping-->hypo
hypopigmentation -->Hyperfluorescence |
|
|
Term
| What is the autofluorescent component of lipofuscin triggered by light exposure |
|
Definition
|
|
Term
| Where in the retina is drusen found |
|
Definition
| Between BM of RPE and inner collagenous zone of Bruch's |
|
|
Term
These substances make up what material found in diseased retina
Proteins, Vitronectin, Amyloid, Inflammatory components & Immunoligcal products |
|
Definition
|
|
Term
| Drusen accumulation is thought to be due to what process |
|
Definition
| Inflammation in the subretinal space |
|
|
Term
| How does the presence of drusen affect the chance of developing macular abnormalities |
|
Definition
|
|
Term
|
Definition
Large Soft
Small Hard
Familial
Calcific |
|
|
Term
| Small Hard vs. Large Soft Drusen: size in relation to BV |
|
Definition
Small=half a vein width
Intermediate=smaller than full width
Large=size of large vein at disc margin |
|
|
Term
| Small Hard vs. Large Soft Drusen: Borders |
|
Definition
Small=well-defined
Large= fluffy, indistinct |
|
|
Term
| Small Hard vs. Large Soft Drusen: AMD diagnosis |
|
Definition
Small-NOT enough to make diagnosis
Intermediate-enough for diagnosis
Large Soft=enough to make AMD diagnosis!! |
|
|
Term
| Small Hard vs. Large Soft Drusen: association with RPE dysfunction |
|
Definition
Small=FOCAL dysfunction
Large=DIFFUSE dysfunction |
|
|
Term
| Large Soft Drusen may appear to similar to what other retinal problem |
|
Definition
| Clinically identical to RPE detachments |
|
|
Term
| Coalescence of Large Soft Drusen can cause what other retinal problem |
|
Definition
|
|
Term
| FA of Soft Drusen: 2 factors that contribute to the degree of fluorescence |
|
Definition
1. Quantity of pigment in RPE
2.Lipid content |
|
|
Term
| Which type of drusen: bilateral, elongated and radiating |
|
Definition
|
|
Term
| Symptoms of Familial Drusen and when they occur |
|
Definition
| 20-30 yo, decreased VA, metamorphopsia, paracentral scotoma |
|
|
Term
| DDX between calcific drusen and hard exudates? |
|
Definition
Based on level in the retina
Drusen=Deep
Exudates= Superficial |
|
|
Term
| Term for long standing drusen that leave patches of atrophy and deposits |
|
Definition
|
|
Term
| Sharply demarcated, smooth, dome-shaped, elevations of RPE |
|
Definition
|
|
Term
| What may result from a collapsed, non-resolved PED |
|
Definition
|
|
Term
| Appearance of FA of a PED |
|
Definition
| gradual, uniform staining of sub-RPE |
|
|
Term
|
Definition
|
|
Term
| 3 names for non-exudative AMD |
|
Definition
Dry
Atrophic
Non-neovascular |
|
|
Term
| What proportion of Nonexudative AMD progresses to wet |
|
Definition
|
|
Term
| What proportion of late stage AMD is wet/exudative |
|
Definition
|
|
Term
| True or False Dry AMD is accompanied by CNV and sub-retinal exudates |
|
Definition
|
|
Term
| Vision loss due to Nonexudative AMD is most noticable in what conditions |
|
Definition
|
|
Term
| Visual symptoms of intermediate dry AMD |
|
Definition
blurred vision/blind spot
Metamorphopsia
Reduced contrast sensitivity |
|
|
Term
| Geographic Atrophy is characterized by gradual loss in these 3 structures |
|
Definition
RPE
Choriocapillaris
Photoreceptor function |
|
|
Term
| Geographic Atrophy results in what changes regarding the Outer Nuclear Layer |
|
Definition
| It comes to rest directly on the basement membrane of the RPE |
|
|
Term
| How does the Outer plexiform layer change due to Geographic Atrophy |
|
Definition
| Becomes thinned and vacuoled |
|
|
Term
| Geographic atrophy accounts for _____________ of visual morbidity in AMD |
|
Definition
|
|
Term
| Vision loss due to geographic atrophy is most noticed during what type of visual activities |
|
Definition
|
|
Term
| 2 objective findings associated with geographic atrophy |
|
Definition
Choroidal atrophy
Large choroidal vessels become more prominent |
|
|
Term
| Approx Follow up time for Geographic Atrophy |
|
Definition
| 6-12 months depending on severity/extent |
|
|
Term
| What is the HALLMARK of exudative AMD |
|
Definition
| Choroidal neovascularization |
|
|
Term
| How does CNV cause detachment of the RPE or sensory retina |
|
Definition
| The new vessels leak fluid that detaches the layers |
|
|
Term
| Leakage in Exudative AMD can lead to 4 complications |
|
Definition
Serous detachment of RPE
Lipid exudation
Hemorrhage
RPE tears |
|
|
Term
| 3 subjective visual complaints associated with CNV |
|
Definition
Distorted vision
Reduced Vision
Color distortion |
|
|
Term
| Pt presents with visual complaints consistent with CNV, name 3 things you should do |
|
Definition
Dilate
OCT
refer for FA STAT |
|
|
Term
You see these 4 things
Gray green membrane
Sensory retinal detachment
subretinal/sub-RPE hemorrhage
Hard exudates
What is this? |
|
Definition
|
|
Term
| How does acuity at time of diagnosis relate to prognosis of AMD |
|
Definition
| The worse the acuity the worse the prognosis |
|
|
Term
| Name a new technology used to monitor progression of AMD |
|
Definition
| Preferential Hyperacuity Perimeter |
|
|
Term
|
Definition
| much more sensitive in detecting disease |
|
|
Term
| Disadvantage of PHP over AG |
|
Definition
| PHP has a higher rate of false positives |
|
|
Term
| 3 types of CNV membranes on FA |
|
Definition
Classic CNVM
Minimally classic CNVM
Occult CNVM |
|
|
Term
| Which type of CNVM is most common |
|
Definition
|
|
Term
| Which type of CNVM has a well defined membrane |
|
Definition
|
|
Term
| Which type of CNVM fills with dye in a lacy pattern |
|
Definition
|
|
Term
| Which type of CNVM has a poorly defined membrane and less precise features |
|
Definition
|
|
Term
| 2 methods to confirm diagnosis of CNVM |
|
Definition
OCT
FA is a must to determine treatment |
|
|
Term
| Name 5 serious complications of CNV |
|
Definition
Hemorrhagic RPE Detachment
Hemorrhagic sensory detachment
Vitreous hemorrhage
Disciform scarring
Massive exudation |
|
|
Term
FA of a hemorrhagic RPE detachment will show HYPERfluorecence corresponding to the ___________________
and hypofluorescence corresponding to the ____________________ |
|
Definition
Hyper=RPE detachment
HYPO=hemorrhage |
|
|
Term
| Differentiate the color difference in hemorrhagic RPE detachment vs. hemorrhagic sensory |
|
Definition
| RPE is very dark red, sensoryis a BRIGHT red |
|
|
Term
| FA of hemorrhagic sensory detachment |
|
Definition
| Will show HYPOfluorescence due to blockage of choroidal fluorescence |
|
|
Term
Vitamin E
Vitamin C
Beta-carotene
These substances all have what in common |
|
Definition
|
|
Term
| Name 2 macular pigments thought to reduce risk/severity of AMD |
|
Definition
|
|
Term
| AREDS2 study-looking at the effects of higher doses of which 3 substances |
|
Definition
| lutein, zeaxanthin an domega-3 fatty acids |
|
|
Term
| AREDS2 study-looking at the effects of removing which substance from the original formula |
|
Definition
|
|
Term
| AREDS2 study-looking at the effects of reducing the amount of which substance in the formula |
|
Definition
|
|
Term
| 6 lifestyle choices we can educate our patients about to reduce AMD |
|
Definition
UV400 protection
balanced diet/green leafy vegetables
antioxidants
exercise
HTN control
Quitting smoking |
|
|
Term
| DDX of Hard exudates vs. Drusen-difference in location in retina? |
|
Definition
Hard exudates=between IPL and INL
Drusen=RPE |
|
|
Term
| Name 3 vascular diseases associated with Cotton wool spots |
|
Definition
|
|
Term
| Name 4 'diseases' associated with hard exudates |
|
Definition
DR
HTN retinopathy
Coat's dz
CNV |
|
|
Term
| What is Macula Risk (ArcticDx)? |
|
Definition
| Commercial genetic test (cheek swab) that measures inheritable risk factors for AMD |
|
|
Term
| What did the AREDS study research? |
|
Definition
| how vitamin and mineral supplements affect the progression of AMD |
|
|
Term
| Result of study on use of fenretinide to treat GA |
|
Definition
| slows down damage from A2E and lipofuscin, also reduced the rate of conversion to CNV by 2 fold |
|
|
Term
| 2 forms of destructive therapy for wet AMD |
|
Definition
Laser photocoagulation
Photodynamic therapy |
|
|
Term
| Which levels of progression of AMD had the best results in the Macular Photocoagulation Study |
|
Definition
| Those with smaller lesions and worse initial Vas had better and earlier results |
|
|
Term
| How did the TAP study (tx of AMD with PDT) find PDT affected baseline VAs |
|
Definition
| It was found to preserve baseline VA whereas those who were untreated were found to have worse Vas after 2 years |
|
|
Term
| PDT seems to work best for which type of CNV according to recent studies |
|
Definition
|
|
Term
| Name 4 available VEGF inhibitors |
|
Definition
Macugen
Lucentis
Avastin
Eylea |
|
|
Term
| Name 3 complications due to Macugen (anti-VEGF) injection |
|
Definition
Endophthalmitis
Traumatic cataract
RD |
|
|
Term
| According to the presented studies, how does Macugen affect AMD |
|
Definition
| delays the progression of AMD, pts still get worse just not as quickly as thoe untreated |
|
|
Term
| Of the 4 anti-VEGF meds, which does not bind to ALL forms of VEGF |
|
Definition
|
|
Term
| Name 6 ocular complications due to Lucentis |
|
Definition
Conj hemes
eye pain
vitreal floaters
increased IOP
Endophthalmitis
Cataracts |
|
|
Term
| In the ANCHOR study, which had better results, Lucentis or PDT |
|
Definition
|
|
Term
| When did VA improvement peak in studies on Lucentis |
|
Definition
| at 4 months and then it plateaued |
|
|
Term
| What is Avastin FDA approved to treat? |
|
Definition
|
|
Term
| General results of the CATT study (Lucentis vs. Avastin) regarding central retinal thickness |
|
Definition
| Decrease in thickness was greater with Lucentis monthly than any other group |
|
|
Term
| General results of the CATT study (Lucentis vs. Avastin) regarding serious systemic effects |
|
Definition
| Proportion of serious systemic effects was higher with Avastin than with Lucentis |
|
|
Term
| How does the cost of monthly injections of Lucentis vs. Avastin compare |
|
Definition
Lucentis monthy=$24 000
Avastin Monthly- $600 |
|
|
Term
| Which anti-VEGF has the longest duration |
|
Definition
|
|
Term
| Recommended dosage for Eylea |
|
Definition
| 1X/month for 3 month then every other month |
|
|
Term
|
Definition
naked endo cells at the edge of the neo complex that lead the expansion of the membrane.
They produce a substance that recruits pericytes which then act as a barrier to anti-VEGF monotherapy |
|
|
Term
| What substance do Tip cells produce |
|
Definition
| Platelet Derived Growth Factor |
|
|
Term
| Why must anti-VEGF tx be continued forever |
|
Definition
| Only the tip cells are killed, thus expansion is inhibited but the remainder of the membrane is unaffected. It will expand once therapy stops |
|
|
Term
| What substance does Fovista inhibit? |
|
Definition
|
|
Term
| What were the results of treating AMD patients with both Lucentis and Fovista |
|
Definition
| 62% additional benefit, ie. more letters gained with combo tx compared to monotherapy |
|
|
Term
| How does treatment with triamcinolone affect progression of neo |
|
Definition
| decreases vascular permeability and decreases VEGF |
|
|
