Advances in Diagnosis and Treatment of AMD

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Advances in Diagnosis and Treatment of AMD
Speakers: Chris Putnam, OD
Hours: 2hrs | 91225-TD

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Age-related macular degeneration (AMD) is one of the leading causes of blindness in developed nations. Non-proliferative maculopathy comprises a substantial percentage of total AMD cases and recent advances in detection, diagnosis, treatment and management have placed a spotlight on the crucial role that optometry must play in primary care healthcare delivery A review of emerging and existing imaging capabilities paired with more recent developments in disease-specific screening will be presented along with an analysis of current medical and oral supplementation. A detailed discussion of nutraceutical strategies used in atrophic age-related maculopathy will be discussed as well as the developing role of genetic testing as it related to tailored supplementation strategies.

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Quiz

1. Clinically speaking, what is the approximate diameter of the human macula?*

A - 0.3mm

B - 1.5mm

C - 5.5mm

D - 7.5mm

2. The macular ganglion cell complex (GCC), as measured by the Zeiss Cirrus OCT, is comprised of all layers EXCEPT:*

A - Retinal nerve fiber layer (RNFL)

B - Ganglion cell layer (GCL)

C - Inner plexiform layer (IPL)

D - Retinal pigmented epithelial layer

3. According to epidemiologic studies, what ophthalmic condition has the highest level of population prevalence?*

A - Age-related macular degeneration (AMD)

B - Primary open angle glaucoma (POAG)

C - Diabetic retinopathy (DR)

D - Neuromyelitis optica (NMO)

4. Based on recent epidemiologic studies, the following genetic risk factors show the highest association for developing AMD EXCEPT for:*

A - Complement factors (CFH, ARMS2, CFI)

B - Lipid / cholesterol regulation (CETP, ABCA1, apoE)

C - Reglation of extracelluar matrix turnover (TIMP3 and COL8A1)

D - GSTP1 and STARD3

5. The following early retinal findings were associated with development of AMD EXCEPT for:*

A - Microvascular changes within choriocapillaris

B - RPE dysfunction

C - Drusen formation

D - RNFL loss

6. Drusen formation associated with AMD development occurs at which layers?*

A - Bowman’s layer

B - RPE / Bruch’s interface

C - Photoreceptor axons

D - RNFL

7. The following three (3) processes were discussed as the cause of early pathogenesis of drusen formation EXCEPT for:*

A - Inflammation

B - Oxidative stress

C - Disruption of RPE transport mechanisms

D - Presence of MMP-3 biomarkers

8. In the AREDS 2 formulation, lutein and zeaxanthin were substituted for what component found in the original AREDS formulation?*

A - Copper

B - Vitamin C

C - Beta-carotene

D - Zinc

9. What subclinical technique was described in the presentation was described as a functional assessment of macular function capable of identifying incident or early AMD before clinical signs are evident?*

A - Dark adaptometry

B - ETDRS acuity

C - SD-OCT

D - None of the above

10. What subclinical technique was described in the presentation was described as a structural assessment of choriocapillaris function capable of identifying incident or early AMD before clinical signs are evident?*

A - 10-2 Humphrey visual field

B - Non-contact tonometry

C - Watzke-Allen sign

D - Optical coherence tomography angiography (OCTA)

11. _______________ was defined as exposure to low-intensity visible to NIR (500-1000 nm) allows high tissue penetration and offers a non-invasive approach for the treatment of atrophic AMD.*

A - AREDS2 supplementation

B - Photobiomodulation (PBM)

C - High dose atorvastatin treatment

D - Pars plana vitrectomy (PPV)

12. Effective retinal nutraceutical compounds share a common chemical structural component capable of free radical neutralization and singlet oxygen quenching known as (a) ________*

A - Hydroxyl group (-OH)

B - Benzene ring

C - Elemental zinc (Zn)

D - None of the above

13. The following flavonoids were discussed in the lecture as showing peer-reviewed evidence of a protective effect at the level of the RPE EXCEPT for:*

A - Quercetin

B - Resveratrol

C - Curcumin

D - Ascorbic acid

14. The discussed systematic review and meta-analysis of macular pigment found beneficial associations with what visual functions EXCEPT for:*

A - Photostress recovery

B - Glare disability

C - Contrast sensitivity

D - Migraine severity reduction

15. The discussed systematic review and meta-analysis of macular pigment found beneficial associations with what visual functions?*

A - Photostress recovery

B - Glare disability

C - Contrast sensitivity

D - All of the above

16. The following three (3) proposed hypotheses of macular pigment (MP) function at the retinal level were discussed EXCEPT for:*

A - Protection Hypothesis

B - Optical Hypothesis

C - Neural efficiency hypothesis

D - Inflammatory hypothesis

17. According to the paper, “Retinal pathological features and proteome signatures of Alzheimer’s disease”, what specific cell type showed ~80% loss in cortical areas associated with memory and are also identifiable in retinal imaging?*

A - Grandmother cells

B - Microglial cells

C - Photoreceptor axons

D - RPE

18. What chart, available as a patient handout, was discussed in the presentation as more sensitive than the standard Amlser grid (Chart 1)?*

A - Zhang’s ring

B - Dry eye checklist

C - Chart 7 with foveal detail discrimination of 0.5o or 150μm

D - VFQ 25

19. In addition to xanthophyllic carotenoids, what other nutraceutical class was discuss as having peer-reviewed evidence of decreasing AMD incidence over 15 years?*

A - Polyphenols

B - Carotenes

C - Heavy metals

D - Trace elements (i.e. Zn and Cu)

20. The AREDS2 formulation has demonstrated clinical evidence of reducing the risk of AMD progress in what stage of the disease?*

A - (-) maculopathy

B - Mild maculopathy

C - Intermediate maculopathy

D - No evidence exists for the usage of AREDS2 in atrophic AMD

OD Information

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Educational Survey

As a result of this lecture, I have a better understanding of the epidemiology of macular degeneration:*

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

As a result of this lecture, I have a better understanding of the retinal findings related to Age-Related Macular Degeneration:*

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

As a result of this lecture, I have a better understanding of macular pigment optical density and dark adaptometry for the subclinical AMD diagnosis:*

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

As a result of this lecture, I have a better understanding of OCT, OCT Angiography, and Preferential Hyperacuity Perimetry for the subclinical AMD diagnosis:*

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

As a result of this lecture, I have a better understanding of nutraceuticals in the treatment of Age-Related Macular Degeneration:*

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

As a result of this lecture, I have a better understanding of Syfovre and Izervay for the treatment of Geographic Atrophy:*

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

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