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Good Hope Hospital Eye Clinic

Geographic dry age related macular degeneration (ARMD)David Kinshuck

 

Low vision & Macula Disease

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Macular degeneration

dry ARMD

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Types of wet ARMD

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Geographic atrophy (GA)

(on separate page)

Areas of thin retina develop, like the patterns of countries of the world. The areas get bigger over years, slowly causing more damage to the sight. Geographic atrophy is the main type of dry ARMD. See a photo

Geographic atrophy (GA) accounts for a third of ARMD, with new 12,000 cases a year in the UK. It is believed to be caused by retinal pigment epithelial atrophy leading to cell death. It is best examined with the autofluorescence technique but this is seldom available Retina 2010. There is no treatment available yet, although trials are in place. FAF photo. Atrophic myopic macular degeneration is usually similar.

We now know here that the risk of passive smoking (doubles the risk) and personal smoking (triples the risk) of both geographic atrophy. See genes and here.

geographic macular degeneration, diagram

It is now clear that GA can lead to wet ARMD, particularly if the GA has an irregular outline ('lobulated'). There is a gene contribution from chromosome 10 genes. This is a more rapidly progressing form, with basal laminar deposits.

So GA is not one disease...it  is the end stage of many different types of 'dry' ARMD, and an intermediate type in others. It is still not known whether the primary priblem is in the retinal pigment epithelium, choroid, or photoreceptors. GA affects 1/3 people >75y.

Wet ARMD may develop, but anti-VEGF will not improve sight BJO 2012 (TTreatment may slow down visual loss.)

enlarge...white arrow is pointing to the geographic change. This progressed over 7 years. Just recently, sight deteroirated, and there are cnv (wet ARMD) which has just begun (blue arrow). Patient male, born 1932. (Only 7% of GA leads to cnv). geographic ARMD with cnv Autofluorescence can be used to predict the progression rate.
Lipofuscin deposits demonstrate autofluorescence, with the stressed affected retina showing up white, the atrophic retina black. Crystalline and soft drusen may turn into areas of GA.
Night vision, age, smoking, blood pressure etc can be used to predict progression. Rods tend to be affected first, then cones.

New treatment

geographic age related macular degeneration

enlarge  geographic ARMD

Progression rate

Eye 2012:

  • 2mm2/year in area
  • AREDS supplements no help
  • from prartial to cenral in 2 years (but I think more unpredictable than this)
  • unilateral to bilateral 7 years

 

 

Apologies to visitors for all the site moves. It is now here www.goodhopeeyeclinic.org.uk/  and hopefully will not move again.

Eye website feedback -- Heartlands -- page edited June 2012 -- Public transport to Good Hope --