Macular Degeneration, Age-Related

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  • Age-related macular degeneration (ARMD) is the leading cause of irreversible, severe visual loss in persons age >65 years.
  • ARMD results in pigmentary changes in the macula or typical drusen associated with visual loss to the 20/30 level or worse, not caused by cataract or other eye disease, in individuals >50 years of age, although some definitions exclude age or visual acuity criteria.
  • Stages
    • Atrophic/nonexudative
    • Neovascular/exudative
  • System(s) affected: nervous
  • Synonym(s): senile macular degeneration; subretinal neovascularization (SRN)


  • Neovascular/exudative form is rare in blacks and more common in whites.
  • Predominant sex: female

  • In the Framingham Eye Study (FES), drusen were noted in 25% of all participants who were ≥52 years of age. ARMD-associated visual loss was noted in 5.7%.
  • Atrophic/nonexudative stage accounts for 20% of cases of severe visual loss.
  • Neovascular/exudative stage accounts for 80% of cases of severe visual loss.

Per FES study:

  • People 65 to 74 years old: 11%
  • People ≥75 years old: 27.9%

Etiology and Pathophysiology

  • Breaks in the Bruch membrane allow choroidal neovascular membranes (CNVMs) to invade the retinal pigment epithelium (RPE) and grow into the subretinal space.
  • Atrophic/nonexudative: drusen and/or pigmentary changes in the macula
  • Neovascular/exudative: growth of blood vessels underneath the retina
    • Polypoidal choroidal vasculopathy is a subtype of exudative ARMD.
  • Visible light can result in the formation and accumulation of metabolic by-products in the RPE, a pigment layer underneath the retina that normally helps remove metabolic by-products from the retina. Excess accumulation of these metabolic by-products interferes with the normal metabolic activity of the RPE and can lead to the formation of drusen.
  • Neovascular stage generally arises from the atrophic stage.
  • Most do not progress beyond the atrophic/nonexudative stage; however, those who do are at a greater risk of severe visual loss.

  • Genetic susceptibility may be a factor in ARMD: ~25% genetically determined
  • Complement factor H is an important susceptibility gene for ARMD.
  • Although the development of ARMD may be predicted by specific alleles, the clinical response to antivascular endothelial growth factor (VEGF) is not.

Risk Factors

  • Obesity
  • Ethnicity: non-Hispanic whites
  • Cigarette smoking
  • Chlamydia pneumoniae infection
  • Family history
  • Excess sunlight exposure
  • Blue or light iris color
  • Hyperopia
  • History of cardiovascular disease
  • Short stature
  • High plasma high-density lipoprotein cholesterol levels are associated with an increased risk for ARMD.
  • Physical activity is associated with lower risk of early and late ARMD in white populations.
  • Aspirin use
  • Female sex

General Prevention

  • Ultraviolet (UV) protection for eyes
  • Routine ophthalmologic visits
    • Every 2 to 4 years for patients age 40 to 64 years
    • Every 1 to 2 years after age 65 years
  • Patients who take statins, which modify lipid profiles, may have a reduced risk.

Commonly Associated Conditions

  • Presumed ocular histoplasmosis syndrome
  • Exudative retinal detachment
  • Vitreous hemorrhage
  • Other causes of CNVMs

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