Macular Degeneration, Age-Related
Basics
Description
- Age-related macular degeneration (AMD) is the leading cause of visual loss in older persons.
- Classified as:
- Atrophic/nonexudative, such as drusen or macular pigmentary changes
- Neovascular/exudative or neovascular age-related macular degeneration (nAMD)
Epidemiology
- nAMD form is rare in blacks and more common in whites.
- Predominant sex: female
Prevalence
- People 65 to 74 years old: 11%
- People ≥75 years old: 27.9%
Etiology and Pathophysiology
- Atrophic/nonexudative
- Drusen and/or pigmentary changes in the macula. Drusen are deposits of hyaline material between the RPE and Bruch’s membrane (the limiting membrane between the RPE and the choroid).
- Visible light can result in the formation and accumulation of metabolic by-products in the retinal pigment epithelium (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.
- nAMD
- nAMD stage generally arises from the atrophic stage.
- In type 1 neovascularization, breaks in Bruch’s membrane allow choroidal neovascular membranes (CNVMs) to grow into the sub-RPE space. This corresponds to occult CNVMs. Fluid leakage and bleeding can produce a vascularized serous or fibrovascular RPE detachment.
- In type 2 neovascularization, the CNVM passes through the RPE and is located in the subretinal space; typically appears as a lacy or gray-green lesion. This corresponds to classic CNVM.
- Type 3 neovascularization, also known as retinal angiomatous proliferations (RAPS), the neovascularization develops from the deep capillary plexus of the retina and grows downward toward the RPE.
- Polypoidal choroidal vasculopathy (PCV) is a subtype of nAMD and often presents with multiple, recurrent serosanguineous RPE detachments. An RPE detachment is also known as a pigment epithelial detachment (PED). Optical coherence tomography (OCT) features of PCV include multiple PEDs, sharply peaked PED, notched or multilobulated PED, and a hyperreflective ring surrounding an internal hyporeflective lumen beneath a PED.
- nAMD stage generally arises from the atrophic stage.
Genetics
Complement factor H Y402H genotype is an important susceptibility gene for AMD.
Risk Factors
- Obesity
- Cigarette smoking
- Chlamydia pneumoniae infection
- Family history
- Excess sunlight exposure
- Blue or light iris color
- Hyperopia
- Short stature
General Prevention
- Ultraviolet (UV) protection for eyes
- Routine ophthalmologic visits
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Citation
Domino, Frank J., et al., editors. "Macular Degeneration, Age-Related." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816290/all/Macular_Degeneration__Age_Related.
Macular Degeneration, Age-Related. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816290/all/Macular_Degeneration__Age_Related. Accessed December 3, 2024.
Macular Degeneration, Age-Related. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816290/all/Macular_Degeneration__Age_Related
Macular Degeneration, Age-Related [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 December 03]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816290/all/Macular_Degeneration__Age_Related.
* Article titles in AMA citation format should be in sentence-case
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BT - 5-Minute Clinical Consult, Updating
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