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  • image The hallmark sign of age-related macular degeneration (AMD) is the development of drusen in the macula. Drusen are yellow deposits of lipids between the retinal pigment epithelial and Bruch’s membrane that can develop with age.

  • image AMD is identified as the leading cause of blindness in the industrialized world and a top cause of blindness worldwide.

  • image The two most important risk factors for AMD are age and smoking.

  • image The goal of treatment is to slow progression of AMD and prevent severe visual impairment or blindness.

  • image Smoking cessation is the main modifiable risk factor that will slow progression of AMD. Pharmacists and other health professionals can play a vital role in helping people stop smoking.

  • image Antioxidant vitamins and minerals may prevent cellular damage in the retina caused by the formation of free radicals through light absorption. Use may benefit patients the most with medium or large sized drusen and/or geographic atrophy in at least one eye.

  • image For most patients with wet AMD and choroidal neovascularization, the use of intravitreal vascular endothelial growth factor (VEGF) inhibitors and other inhibitor-like drugs have led to improvement in visual acuity.

  • image The appeal of the ranibizumab treat and extend (TREX) approach is the reduction of office visits and medication cost.

  • image VEGF inhibitors and antioxidant vitamins and minerals are the only pharmacologic therapies available that have been shown to improve and stabilize visual acuity in patients with intermediate to advanced AMD.


Preclass Engaged Learning Activity

Watch the three age-related macular degeneration videos on the National Eye Institute. These short videos totaling 3 minutes provide a brief overview to age-related macular degeneration and animation of the pathophysiology. These videos are useful to enhance student understanding regarding the COLLECT and ASSESS steps in the patient care process.


Age-related macular degeneration (AMD) is a neurodegenerative disease that produces irreversible loss of central vision due to damage to the macula, the center region of the retina. AMD is a leading cause of blindness due to age-related changes in the macula and, specifically, the photoreceptor–retinal pigment epithelial (RPE) complex.2

A general familiarity with the anatomy of the eye including the macula and photoreceptor–RPE complex will aid in understanding the disease and treatment mechanisms (Figs. 111-1 and 111-2).3,4 The macula in the middle of the retina is responsible for all central vision, a significant part of color vision, and the fine detail images. The photoreceptor cells of the macula identify light and then transfer the information to the brain to produce an image. Central vision is needed to read, write, drive, watch television, and other typical activities of daily living. AMD reduces central vision, visual acuity, and blue-yellow color sensitivity leading to significant disability (Fig. 111-3).5

FIGURE 111-1

Anatomy of the eye. The macula, in the center of the retina, ...

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