Most common cause of blindness in individuals over 65 years in developed countries

Aetiology

• Not clear - age-related, underlying inflammatory process

Risk factors

• Increasing age
• Smoking
• Positive family history
• Poor nutrition

Pathophysiology

Dry ARMD (~90%)

• Deposition of drusden (accumulation of byproducts - proteins, lipids, and inflammatory mediators) in RPE and between RPE and Bruch membrane results in slow progressive atrophy of the local RPE

Wet ARMD (~10%)

• Neovascularisation in choroid, mediated by VEGF
• New vessels are small and fragile → more likely to haemorrhage so more likely to result in visual loss

Clinical features

Wet ARMD

• Rapid central visual loss
• Distortion (metamorphopsia)

Dry ARMD

• Gradual decline in vision
• Central vision 'missing' (scotoma)

Investigations

Fundoscopy