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0521779407-02 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:18
Age Related Maculopathy 81■patient is given a copy of the grid and is instructed to focus one eye
on the center dot in the grid from a distance of 35 cm (112 in) with
the other eye covered; the procedure is then repeated for evaluation
of the other eye.
■patient is instructed to call the physician if line distortions or sco-
tomas are detected.
■Biomicroscopic (Funduscopic) Examination (Classification of
ARMD or more specifically ARM (Age Related Maculopathy) as
defined by the International ARM Epidemiological Study)
■Early ARM
➣presence of drusen and retinal pigmented epithelium (RPE) pig-
mentary abnormalities (hypopigmentation and hyperpigmenta-
tion).
■Late ARM
➣includes geographic atrophy and exudative disease (detachment
of the retinal pigment epithelium or choroidal neovasculariza-
tion)
■Types of Choroidal Neovascular Membranes (CNVM)
➣Classic (well-defined) or occult (poorly defined)
➣Extrafoveal, Juxtafoveal, or Subfoveal
Fluorescein Angiography
■used to confirm diagnosis and to help determine whether a patient
has the atrophic or exudative form of the disease in order to dictate
managementdifferential diagnosis
■Drusen
➣diseases with retinal flecks simulating drusen include Stargardt’s
disease and fundus albipunctatus
■Geographic Atrophy/Pigmentary Changes
➣can also be caused by Central serous chorioretinopathy, ocu-
lar toxoplasmosis, retinal detachment, North Carolina Macular
Dystrophy, Central Areolar Dystrophy, & others.
■Choroidal Neovascularization – other causes of CNVMs include ocu-
lar histoplamosis, myopic fundus changes, idiopathic choroidal neo-
vascularization, polypoidal choroidopathy, endogenous posterior
uveitis syndromes, and others.management
■All patients with vision loss should be referred to an ophthalmologist;
those with acute loss of vision should be referred urgently.