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Introduction

Macular degeneration (aka age-related maculopathy – ARM) is a condition that causes gradual visual loss, typically in older patients.

It can be split into two types:

  • Dry – atrophic
  • Wet – exudative

Red flags for macular degeneration

  • Decrease in central vision (macula)
  • Distortion of vision – e.g. distorted lines, letter missing when reading
  • Previous visual loss in other eye from macular degeneration

Epidemiology and Aetiology

  • Typically patients aged >55
  • Smoking
    • 3-4x increased risk
  • FHx of macular degeneration
    • 50% chance if 1st degree relative with ARM
  • Diabetes
  • Previous ARM in other eye
  • Dry ARM
    • More common – about 75% of cases
    • Changes occur very gradually
    • Near and distant vision affected
    • Loss is often symmetrical
    • Can progress to wet ARM
  • Wet ARM
    • Vascular proliferation under the retina
    • Treatable
    • Can causes more sudden and abrupt changes in visual acuity

Presentation

  • Decline in visual acuity
    • Affects mainly central vision
    • Difficulty reading, watching TV or recognising faces
    • Distortion of vision – can be tested using an Amsler Grid
  • Usual gradual, but can be acute
  • Visual fields will be normal
  • No pupillary defects, including no relative afferent pupillary defect
  • Normal red reflex

Management

  • High dose vitamin supplementation – AREDS2 formulation
    • e.g. “Macu-vision” or “VisionCare”
  • Advise smoking cessation
  • Patients with recent decrease in vision that is central, or involves distortion – need to be seen within 1 week by ophthalmologist
  • Annual eye examination with optometrist or ophthalmologist

References

  • Murtagh’s General Practice. 6th Ed. (2015) John Murtagh, Jill Rosenblatt
  • Oxford Handbook of General Practice. 3rd Ed. (2010) Simon, C., Everitt, H., van Drop, F.
  • Beers, MH., Porter RS., Jones, TV., Kaplan JL., Berkwits, M. The Merck Manual of Diagnosis and Therapy
  • Macular Degeneration - Health Pathways

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