History and exam
Key diagnostic factors
common
presence of risk factors
blurring or distortion of vision
Often the first symptom of disease.
Can indicate development of macular neovascularisation with leakage of fluid in the macula.
drusen
A frequent feature in the early stages of disease.[21]
Size and quantity differentiate between early stages of the disease (see Diagnostic criteria, Beckman classification of age-related macular degeneration).
macular pigmentary changes
Seen in intermediate age-related macular degeneration, along with drusen.[21]
geographic atrophy
A form of late age-related macular degeneration.
Frequently associated with significant visual loss, especially if central macula (fovea) is involved.[48]
macular neovascularisation
Other diagnostic factors
common
progressive loss of vision in one or both eyes
Occurs in patients as disease progresses and may be more severe when there is development of macular neovascularisation or central geographic atrophy.[41]
fibrovascular pigment epithelial detachment (neovascular age-related macular degeneration [AMD])
Presents as fluid-filled irregular elevation of the neurosensory retina and retinal pigment epithelium. The macular neovascularisation is visible on optical coherence tomography as variable reflectivity under the elevated retinal pigment epithelium.
Commonly occurs as part of the clinical picture of neovascular AMD.[47] Not seen in geographic atrophy, unless patients have both geographic atrophy and neovascular AMD.
fibrovascular scar formation
Typically an end-stage finding.[49]
Scars may be disciform.
If foveal centre is affected, it almost universally results in severe visual loss.
subretinal drusenoid deposits
Small drusen-like deposits that form between the photoreceptors and retinal pigment epithelium. Subretinal drusenoid deposits have been associated with increased risk of progression to late age-related macular degeneration.[41]
Risk factors
strong
increasing age
smoking
family history of disease
One meta-analysis has shown that family history is strongly associated with late age-related macular degeneration (AMD).[14] Polymorphisms associated with a number of genes have been shown to modify AMD risk, including the complement factor H locus, ARMS2/HTRA1, and C3.[20] Other polymorphisms have been identified in genes relating to oxidative stress, lipid metabolism, and neovascularisation.
weak
previous cataract surgery
One meta-analysis has shown that previous cataract surgery is associated with late age-related macular degeneration.[14]
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