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Review
. 2015 Feb 12;4(2):343-59.
doi: 10.3390/jcm4020343.

Age-Related Macular Degeneration: Advances in Management and Diagnosis

Yoshihiro Yonekawa  1 , Joan W Miller  2 , Ivana K Kim  3
Affiliations
Review

Age-Related Macular Degeneration: Advances in Management and Diagnosis

Yoshihiro Yonekawa et al. J Clin Med. .

Abstract

Age-related macular degeneration (AMD) is the most common cause of irreversible visual impairment in older populations in industrialized nations. AMD is a late-onset deterioration of photoreceptors and retinal pigment epithelium in the central retina caused by various environmental and genetic factors. Great strides in our understanding of AMD pathogenesis have been made in the past several decades, which have translated into revolutionary therapeutic agents in recent years. In this review, we describe the clinical and pathologic features of AMD and present an overview of current diagnosis and treatment strategies.

Keywords: age-related macular degeneration; choroidal neovascularization; fluorescein angiography; fundus autofluorescence; optical coherence tomography; retina; vascular endothelial growth factor; visual impairment.

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Figures

Figure 1
Figure 1
Drusen in non-neovascular age-related macular degeneration appear as round, yellow deposits deep in the retina during fundus examination.
Figure 2
Figure 2
Geographic atrophy is an advanced form of non-neovascular age-related macular degeneration. There is sharply demarcated confluent atrophy of the retinal pigment epithelium and overlying outer retina, with a view of the underlying choroidal vasculature (A); on fluorescein angiography, there is a “window defect” during the early frames with transmission of choroidal fluorescence (B); which does not leak in later frames (C).
Figure 3
Figure 3
Choroidal neovascularization is the hallmark of neovascular age-related macular degeneration. There is often thickening or elevation of the retina seen clinically through stereoscopic biomicroscopy (area within arrow heads) (A); On fluorescein angiography, neovascular membranes appear as hyperfluorescent lesions deep in the retina (arrow) that leak over time (B); Spectral-domain optical coherence tomography allows detailed cross-sectional imaging of retinal anatomy. In this patient, there was subretinal fluid (white arrow), and a small adjacent pigment epithelial detachment. Visual acuity was 20/32 (C); After 3 monthly intravitreal injections of ranibizumab, the fluid resolved, and visual acuity improved to 20/20 (D).
Figure 4
Figure 4
Neovascular age-related macular degeneration can also present with significant retinal hemorrhage.
Figure 5
Figure 5
Subretinal fibrotic scarring is the end-stage manifestation of neovascular age-related macular degeneration.
See this image and copyright information in PMC

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