Age-related macular degeneration (AMD or ARMD) is the most common cause of irreversible vision loss in the developed world. AMD is associated with the presence of drusen, without visual loss early in the disease. However, the disease often slowly progresses over years to retinal atrophy and central retinal degeneration with associated loss of central vision. The early form of dry AMD is characterized by small to intermediate sized drusen, without significant vision loss. The intermediate form of dry AMD is associated with loss of retinal pigment epithelium (RPE) and the overlying retinal layers (atrophy), with loss of contrast sensitivity, loss of reading speed, and difficulty with adaptation to changing light conditions. The advanced, nonexudative form of AMD is characterized by the presence of atrophy that can be associated with severe central visual-field loss. In all forms of dry AMD, peripheral visual acuity is preserved. Exudative AMD is associated with the development of choroidal neovascular membranes that result in the development of exudate, subretinal fluid, and hemorrhage, as well as relatively rapid central vision loss and visual distortion.
Patients with age-related macular degeneration (AMD or ARMD) usually report a family history of decreased vision late in life. They often report difficulty with night vision and with changing light conditions. Specifically, patients report changes in Amsler grid self-evaluation and trouble with reading. Commonly, AMD patients report visual fluctuation (ie, days when vision is poor and other days when it appears improved). Patients report difficulty with reading and making out faces.
Evidence shows that patients with early or moderate dry age-related macular degeneration (AMD or ARMD) should consume adequate quantities of antioxidants, including vitamin A, vitamin E, zinc, and lutein. Prevention is the best treatment in this case because no satisfactory method exists to treat dry AMD. Accumulated evidence suggests that AMD is a genetic disease. Therefore, children of patients who have lost vision to AMD are the best candidates for a primary prevention trial.
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