1. AGE-RELATED MACULAR DEGENERATION (AMD)
1. Drusen
2. Drusen and AMD
3. Atrophic AMD
4. Exudative AMD
Pigment epithelial detachment (PED)
Choroidal neovascularization (CNV)

2. Drusen Histopathology Hard Soft Larger, ill-defined spots
Small well-defined
spots
May enlarge and coalesce
Usually innocuous
Increased risk of AMD

3. `` FA of drusen Degree of hyperfluorescence depends on:
Extent of overlying RPE atrophy (window defect)
Amount of staining
Lipid content

4. Drusen and AMD - progression
Atrophic AMD
Exudative AMD

5. Atrophic AMD Progression Initially drusen and non-specific RPE changes
Late RPE (geographic) atrophy

6. Atrophic AMD Fluorescein angiogram Management
Hyperfluorescence from RPE window defect
Low-vision aids if appropriate

7. Signs of Pigment epithelial detachment
Sub-RPE fluid may be clear or turbid
Circumscribed, dome-shaped elevation

8. FA of pigment epithelial detachment
Early, well-defined
hyperfluorescence
Progressive increase in
hyperfluorescence
No increase in size of lesion

9. ICG angiogram of pigment epithelial detachment
Early, well-defined
hypofluorescence
Later, thin surrounding
hyperfluorescent ring
No increase in size of lesion

10. Possible subsequent course of PED
Spontaneous resolution
Geographic atrophy
CNV
RPE rip

11. Choroidal neovascularization (CNV)
Less common than atrophic AMD but more serious
Metamorphopsia is initial symptom
Most lesions are not visible clinically
Suspicious clinical signs
Subretinal blood or lipid
Pinkish-yellow subretinal lesion
with fluid

12. Angiographic classification of CNV
Well-defined (classical)
Occult
Extrafoveal > 200 m from centre of
FAZ
Poorly defined
Juxtafoveal < 200 m from centre of
FAZ
Obscured by PED, blood or exudate
Subfoveal - involving centre of FAZ

13. FA of classical CNV Very early ‘lacy’ filling pattern
Leakage into subretinal
space and around CNV
Late staining

14. ICG angiogram in PED with occult CNV
PED is hypofluorescent
CNV is hyperfluorescent (hot spot)

15. Possible subsequent course of CNV
Haemorrhagic sensory and
RPE detachment
Subretinal (disciform) scarring
Massive subretinal exudation
Exudative retinal detachment

16. Potential indications for laser treatment of CNV
Classic extrafoveal CNV on FA
Occult extrafoveal CNV on ICG
Pre-treatment FA of classic CNV

17. Technique of laser photocoagulation of CNV
Perimeter is treated with overlapping 200 m ( sec) burns
Entire area is covered with high energy burns
Late staining around
margin is normal
Lack of leakage following successful treatment

18. Results of laser photocoagulation of CNV
Initial risk of severe visual loss reduced by over 50%
Frequent subsequent recurrence with subfoveal involvement
Recurrence of CNV several months after initially successful treatment