Differentials
Idiopathic polypoidal choroidal vasculopathy
SIGNS / SYMPTOMS
Signs and symptoms may be similar to exudative age-related macular degeneration, particularly occult forms.
Haemorrhagic pigment epithelial detachment is particularly suggestive.
INVESTIGATIONS
Indocyanine green angiography demonstrates characteristic choroidal polyps.
Optical coherence tomography (OCT) may show pachychoroid or highly peaked/multi-lobular retinal pigment epithelium elevation indicating underlying polyps.
OCT may show thickening of the choroid.
Pachychoroid spectrum
SIGNS / SYMPTOMS
Conditions in the pachychoroid spectrum which may mimic age-related macular degeneration include:
Central Serous Chorioretinopathy (CSCR)
Pachychoroid Pigment Epitheliopathy
INVESTIGATIONS
The choroid may be thickened on optical coherence tomography scanning.
In CSCR there may be subretinal fluid but no macular neovascularisation.
Indocyanine green angiogram may show choroidal hyperpermeability.
Basal laminar drusen
SIGNS / SYMPTOMS
Multiple, discrete, often calcified drusen.
Symmetrical in both eyes.
May be associated with choroidal neovascularisation or pseudovitelliform macular lesions.
Demographic may be different to age-related macular degeneration: may be seen in younger patients and non-white ethnicities.
INVESTIGATIONS
No differentiating tests: differentiated on the basis of history and clinical examination.
Myopic degeneration
SIGNS / SYMPTOMS
Present in patients with high myopia.
Associated with typical features of high myopia: tilted nerve head and posterior staphyloma.
May be associated with macular pigmentary changes and choroidal neovascularisation.
Drusen not present.
Demographic may be different to age-related macular degeneration: may be seen in younger patients and non-white ethnicities.
INVESTIGATIONS
No differentiating tests: differentiated on the basis of history and clinical examination.
Refraction may reveal high myopia: may not be seen if a patient has undergone refractive surgery, such as laser-assisted in situ keratomileusis, or cataract surgery with intraocular lens implantation.
Ocular histoplasmosis syndrome
SIGNS / SYMPTOMS
High incidence in people residing in the Mississippi River Valley and nearby areas.
Peripapillary atrophy and punched-out chorioretinal scars in the macula and periphery observed.
Drusen not present.
May be associated with choroidal neovascularisation.
Demographic may be different to age-related macular degeneration: may be seen in younger patients and non-white ethnicities.
INVESTIGATIONS
No differentiating tests: differentiated on the basis of history and clinical examination.
Angioid streaks
SIGNS / SYMPTOMS
May be associated with choroidal neovascularisation.
Characterised by the presence of angioid streaks on fundoscopic examination.
Drusen not present.
Demographic may be different to age-related macular degeneration: may be seen in younger patients and non-white ethnicities.
May be associated with Ehlers-Danlos syndrome, Paget's disease, pseudoxanthoma elasticum, and sickle cell disease.
INVESTIGATIONS
No differentiating tests: differentiated on the basis of history and clinical examination.
Optical coherence tomography angiography and fluorescein angiography may be useful to confirm the presence of angioid streaks.
Traumatic choroidal neovascularisation
SIGNS / SYMPTOMS
May be associated with rupture of Bruch's membrane with subsequent choroidal neovascularisation.
Drusen not present.
Usually unilateral.
Demographic may be different to age-related macular degeneration: may be seen in younger patients and non-white ethnicities.
Other findings of ocular trauma may be present.
INVESTIGATIONS
No differentiating tests: differentiated on the basis of history and clinical examination.
Idiopathic choroidal neovascularisation
SIGNS / SYMPTOMS
Drusen not present.
Usually unilateral.
Demographic may be different to age-related macular degeneration: may be seen in younger patients and non-white ethnicities.
INVESTIGATIONS
No differentiating tests: differentiated on the basis of history and clinical examination.
Adult vitelliform dystrophy
SIGNS / SYMPTOMS
Lipofuscin/vitelliform deposition in between neurosensory retina and retinal pigment epithelium. Macular pigmentary changes.
INVESTIGATIONS
Lipofuscin deposition may cause increased autofluorescence. Fluorescein angiography, optical coherence tomography, and/or indocyanine green angiography can often help to distinguish entities that may mimic age-related macular degeneration.
Macular branch retinal vein occlusions
SIGNS / SYMPTOMS
Retinal haemorrhages and exudates.
INVESTIGATIONS
Fluorescein angiography, optical coherence tomography (OCT), OCT angiography and/or indocyanine green angiography can often help to distinguish entities that may mimic age-related macular degeneration.
Idiopathic perifoveal telangiectasia
SIGNS / SYMPTOMS
Small aneurysms, haemorrhages, exudates.
INVESTIGATIONS
Fluorescein angiography, optical coherence tomography (OCT), OCT angiography and/or indocyanine green angiography can often help to distinguish entities that may mimic age-related macular degeneration.
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