Benign+Macular+Degeneration

The doctor will start with past medical history. 1 Central vision will be checked and an a ophthalmoscopy will be used to look at the inside of the eye. 1 The Doctor looks at the retina and macula for signs of AMD. 1 AMD is nerve damage to the macula. White yellowish spots on the macula are early signs of AMD. Blood or fluid in the macula are indications of wet AMD. ||
 * **Epidemiolgy:** || Macular Degeneration is the leading cause of legal blindness in people of greater than 55 years of age, in the United States. It affects more than 1.75 individuals in the United States, and this is due to the rapid aging of the population. There are two types, dry and wet. Dry is more common in individuals over the age of 70. Wet only 15% of people who have macular degeneration, but accounts for two-thirds of the people who have significant visual loss.1 ||
 * **Etiology:** || Although there have been small connections made to many different factors, there is no known etiology1 ||
 * **Signs & Symptoms:** || The main sign and symptom is partial loss of vision ranging from mild to severe1 ||
 * **Diagnostic Procedures:** || Macular Degeneration can be detected and diagnosed during a regular eye exam. 1
 * **Histology:** || There are two types of Macular Degeneration:2

__Age related Macular Degeneration (AMD) __

 - Happens slowly and gradual

 - Patient may not notice changes in vision until it starts to affect daily activities like reading and driving.

 - Symptoms are mild at first ,but may become severe.

__Wet Age Related Macular Degeneration (Wet AMD) __

 - Less common. 1 in 10 Patients with AMD develop wet AMD.

 - Cause by blood and fluid leaks under the macula.

 - Vision loss develops rapidly.

<span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif;"> - Vision loss is severe and always permanent. || The Wet Stage- is caused by growth of abnormal blood vessels behind the macula. All wet AMD is considered advanced; however, the dry form of AMD has three stages:
 * **Lymph node drainage:** || <span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif;">Lymph node drainage is not a concern with macular degeneration as it is a condition due to damage of the retina. ||
 * **Metastatic spread:** || Metastatic spread is not possible with this benign condition. It is a condition that effects the eye only.3 ||
 * **Grading:** || There is no universally agreed grading system for macular degeneration.3 ||
 * **Staging:** || The Dry Stage- the delicate tissues of macula become thinned and slowly lose function. This type is more common.
 * Early AMD - patients have several small drusen or a few medium-sized drusen. There is no vision loss or symptoms at this stage.
 * Intermediate AMD - patients have many medium-sized drusen or one or more large drusen. Some people may need more light for tasks such as reading. A blurry spot may appear in the center of the visual field.
 * Advanced AMD - patients exhibit a large number of drusen deposits and a breakdown of RPE and photoreceptor (light sensitive) cells and supporting tissue in the retina. A large blurry spot occurs in the center of the visual field and can become larger and darker, eventually causing a complete loss of central vision." 3 ||
 * **Radiation side effects:** || Radiation therapy is used due to its effect on the endothelium and inflammation modulation, and may cause mild side effects such as eye irritation. 4 ||
 * **Prognosis:** || Macular degeneration is known to cause loss of vision, and is not considered life threatening. 4 ||
 * **Treatments:** || Treatments for macular degeneration include thermal lasers, verteporfin photodynamic therapy, vascular endothelial growth factor targeted therapy, and radiation therapy. Typical external beam radiation therapy employs doses of less than 25 GY to the whole eye. 4 ||
 * **TD 5/5:** || The macula encompasses the posterior aspect of the retina, so TD 5/5 guidelines for the retina should be followed. TD 5/5 for the retina is 45 Gy. ||
 * **References:** || # <span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif;">WebMD, Inc. Macular Degeneration. Available at:[] Accessed: June 3, 2012.
 * 1) <span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif;">Green WR. Histopathology of age-related macular degeneration. Mol Vis. 1999. Nov 3;5:27. Review. PubMed PMID: 10562651.
 * 2) <span style="background-color: #ffffff; color: #ff0000; font-family: 'Times New Roman',Times,serif; font-size: 14px;">Chao KS, Perez CA, Brady LW. //Radiation Oncology Management Decisions//. 3rd edition. Philadelphia, PA: Lippincott Williams & Wilkins.2011; 679-680.
 * 3) <span style="background-color: #ffffff; color: #800080; font-family: Arial,Helvetica,sans-serif;">Hoppe RT, Phillips TL, Mack III M. Leibel and Phillips Textbook of Radiation Oncology. 3rd ed. Philadelphia Pa: Elsevier Saunders; 2010. ||

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