• see dry ARMD
• progression rate
  

• Coping / Low vision
  • Hints & Coping
  • Coping with one eye
  • Magnification
  • Low Vision Assessment
  • Low vision Gateway (US)
• Support
  • Rehabilitation & local services
  • Birmingham Focus (link)
  • Walsall Eyes Newsletter
  • Macular Disease Society
  • Rehabilitation Centre
  • RNIB.talk and support
• Macular degeneration
  • Explanation (link)
  • Understanding
  • Pathology ARMD
• dry ARMD
  • hard drusen
  • soft drusen
  • geographic
  • AOFMD
• none-ARMD macula
• ERM
• VMT
• macular hole
• Juvenile macular dystrophies
• PFT parafoveal telangiecasia
• Proliferative vitreoretinopathies
• wet ARMD & Lucentis
  • wet ARMD
  • Lucentis treatment program
  • myopic macular degeneration
  • Macular degeneration: understanding
  • Risk simulation
  • Diabetic maculopathy (link)
  • PDT program
  • New drugs..Lucentis, Macugen, Avastin
  • A table comparing drugs
  • Studies published and in progress
  • Audio interview (NEJM)
  • VMC
• Types of wet ARMD
  • Occult type 1, PED
  • Occult type 2
  • Classic
  • Rip
  • Polypoidal
  • RAP
  • extensive subfoveal haemorrhage
  • Peripapillary CNV
• Myopia
  • refraction
  • dry macula changes
  • wet macula disease (CNV)
• Abbreviations
• Animations etc
  • Large diagram 1
  • Large diagram 2
  • wet /dry ARMD full size
  • Lucentis
  • SWF file for laptops: ARMD animation: 1mb
  • Excellent animation..link
  • VMT vit-mac-traction
• Cases for students etc
  • 1 ARMD etc
  • 2 hard drusen
  • 3 Central Serous Retinopathy
  • 4 Wet macular degn (CCNV)
  • 5 Occult CNV
  • 6 Soft drusen
  • Case Pre-macula haem
  • Case Bests
  • 10 PDT
  • 11 rip
  • 12 CNV
  • 13 CSR & PED
  • 14 Dry/Occult
  • 15 polypoidal
  • 16 myopic early CNV
  • Atlas...Bests, Haem
  • 17 macula hole
  • 18 more fluid with oct
  • 19 fluid reaccumulates
  • 20 peds & nsd
  • 21 AOFVD
  • 22 AOFVD/ERM
  • 23 speckles
  • 24 VMT
  • 25 epiretinal membrane
  • 26 Juvenile retinoschisis
  • 
    
  • 27 early classic
• Further information
  • dry ARMD (link)
  • US Aging Times Review
  • Links
  • RNIB page (link)
  • epidemiology
  • Genes
  • biology of ARMD
• Lifestyle
  • Alcohol
  • Smoking
  • Diet
  • Blood pressure
  • exercise

(on separate page)

Areas of thin retina develop, like the patterns of countries of the world. The areas get bigger over years, slowly causing more damage to the sight. Geographic atrophy is the main type of dry ARMD. See a photo

Geographic atrophy (GA) accounts for a third of ARMD, with new 12,000 cases a year in the UK. It is believed to be caused by retinal pigment epithelial atrophy leading to cell death. It is best examined with the autofluorescence technique but this is seldom available Retina 2010. There is no treatment available yet, although trials are in place. FAF photo. Atrophic myopic macular degeneration is usually similar.

We now know here that the risk of passive smoking (doubles the risk) and personal smoking (triples the risk) of both geographic atrophy. See genes and here.

It is now clear that GA can lead to wet ARMD, particularly if the GA has an irregular outline ('lobulated'). There is a gene contribution from chromosome 10 genes. This is a more rapidly progressing form, with basal laminar deposits.

So GA is not one disease...it  is the end stage of many different types of 'dry' ARMD, and an intermediate type in others. It is still not known whether the primary priblem is in the retinal pigment epithelium, choroid, or photoreceptors. GA affects 1/3 people >75y.

enlarge...white arrow is pointing to the geographic change. This progressed over 7 years. Just recently, sight deteroirated, and there are cnv (wet ARMD) which has just begun (blue arrow). Patient male, born 1932. (Only 7% of GA leads to cnv).

Autofluorescence can be used to predict the progression rate.
Lipofuscin deposits demonstrate autofluorescence, with the stressed affected retina showing up white, the atrophic retina black. Crystalline and soft drusen may turn into areas of GA.
Night vision, age, smoking, blood pressure etc can be used to predict progression. Rods tend to be affected first, then cones.

enlarge  geographic ARMD

Eye 2012:

• 2mm2/year in area
• AREDS supplements no help
• from prartial to cenral in 2 years (but I think more unpredictable than this)
• unilateral to bilateral 7 years