Optometric Management of ARMD

Prevalence

• 350,000-500,000 in the uk 'blind' from ARMD
• Most of the impairment is due to wet ARMD
• Most of that is untreatable

Incidence

• 21,000 new cases every year
• 10% added risk/year to fellow eye

Non modifiable Risk Factors

• Age
• Genetic predisp
• Gender (females 2xrisk)
• Race
• Iris colour (light pig)
• Type I diabetes
• Rx
• Cataract (can vary w/UV exposure)
• Handgrip strength ('weak' px)
• OD appearance
• Size @ birth

Modifiable Risk Factors

• Smoking
• Drink
• Socioeconomic factors
• Nutrition
• Body Mass Index
• Dietary Fat Intake
• CV disease
• Hypertension
• No statin usage (if you have cholesterol more likely to get it)
• Aspirin
• Type II diabetes
• Sunlight exposure
• Birth of child (px weaked if had 5 or 6 kids)

Optometric Assessment of the ARMD Px

• History - co-morbidity; hypertension, diabetes, hyper cholesterol, smoking, excessive alcohol
• Acuity - If poss use logMAR - more immediate steps so can spot disease early
• Contrast sensitivity
• Amsler - History of metamorphopsia, give copy to put on fridge
• Refraction
• Dilated assessment w/Volk lens
• Decisions - if WET refer. Will see vasc changes, exudate, haem, oedema, neovasc
• Decisions - if DRY monitor especially if they have large confluent drusen

Medical Management of the ARMD Px

• Flu Ang exam to clarify/make diag of wet/dry
• Treat: Laser Photocoagulation - leakage away from the fovea
• Treat: Anti VEGF treatment - intraocular injection which blocks neovasc and causes shrinkage of existing vessels
• Macular translocation - surgery for ppl w/huge scars
• Future: retinal implants. Currently only for ppl who are totally blind