New Material Review Sheet for Final - Posterior Segment & Ocular Disease Spring 2026

you must either run an OCT, refer to ophthalmology, or both

What must you do when you are unsure about what is happening in the macula?

white

In the US, macular degeneration is most common in (black/white) individuals

hypoxic stress and oxidative reactions AT THE LEVEL OF THE RPE AND OUTER RETINAL LAYERS

What is the pathophysiology of AMD?

-age

-smoking

-race

-genetics

What are the most significant risk factors for AMD?

-intake of dietary anti-oxidants

-intake of omega-3 fatty acids

-amount of exercise

-UV exposure

-serum cystatin levels elevated

-blue > brown iris

-divorced > married

What are the "other" risk factors for AMD (Aside from the significant ones)?

-drusen

-pigmentary changes

-RPE clumping

-RPE window defects/dropout

-geographic atrophy (end stage)

What retinal changes does DRY AMD include?

dark brown/black

What color is RPE clumping in AMD?

dull yellow

What color is drusen in AMD?

dull yellow

What color is the RPE dropout/window defects of AMD?

loss of retinal tissue over the top of an area of RPE loss

What are effaced window defects?

orange/dark red

What color will effaced window defects be with AMD?

referral

Serous detachment w/ AMD is always a _______

leaking choroidal neovasc

There is assumed to be what associated with serous detachment?

appears as a raised, yellow/orange area under the RPE (sub-RPE) and maybe under the retina (subretinal)

What does serous detachment look like on retinal OCT?

No

Will a non-exudative choroidal neovascular membrane leak on FA?

No

Will a non-exudative choroidal neovascular membrane leak on indocyanine green?

Yes

Will a non-exudative choroidal neovascular membrane EVENTUALLY leak?

the area of the RPE detachment is filled almost entirely by the neovascularization itself

What does the OCT-A overlay of a non-exudative choroidal neovascular membrane show?

NO -- Wet AMD suggests vascular leakage

Is non-exudative choroidal neovascular membrane termed WET AMD?

-hemorrhage

-neovascularization

What does WET macular degeneration include?

darker

If there is hemorrhage, the subRPE portion is (brighter/darker)

brighter

If there is hemorrhage, the subretinal portion is (brighter/darker)

Yes -- anytime

Whenever Bruch's membrane is compromised, is there risk of choroidal neovascularization?

Yes -- there is a break in Bruch's membrane

Is choroidal neovascularization possible in AMD?

hyperreflective deposits above (retina side) the RPE

How do subretinal drusenoid deposits appear on OCT?

bad

Subretinal drusenoid deposits are a (good/bad) sign

Early AMD

What form of AMD is this pic?

Early AMD

What form of AMD is this pic?

Intermediate AMD

What form of AMD is this pic?

Advanced AMD

What form of AMD is this pic?

-unlimited small drusen

-less than 5 intermediate drusen

What classifies early AMD?

-5-20 intermediate drusen

-Intermediate RPE clumps

-less than 4 large drusen

-window defects may be present but are not geographic atrophy

What classifies intermediate AMD?

-More than 20 intermediate drusen

-Geographic atrophy

-Choroidal neovasc

-Nonexudative macular neovascularization (not Wet AMD)

What classifies Advanced AMD?

false

True or False:

Pigmentary changes are considered mild or early AMD

RPE window defects

Which are worse?

RPE window defects or RPE pigment clumping

OCT for sure in advanced AMD! FAF maybe

What do intermediate or advanced stages of AMD require?

No -- but you must at least get an OCT

Do you technically HAVE to refer a patient with no choroidal neovasc? What MUST you do in these advanced/intermediate stages?

-large numbers of intermediate drusen

-Any number of large drusen

-Any significant (intermediate or larger) pigmentary changes

What are the AMD Red flags?

-large drusen (>125um)

-Intermediate drusen (63-125um)

-Pigmentary abnormalities (hyperpigmentation, hypopigmentation, non central geographic atrophy)

-bilaterality

What are the signs of worsening AMD?

-drusen

-RPE window defects

-Serous RPE (PED) & serous retinal detachment

When imaging a patient with AMD, what should we look for on OCT?

in the RPE

Where will drusen be on OCT of a patient with AMD?

thinned/missing RPE with extra choroidal reflectivity

What are RPE window defects that can be seen on OCT imaging of an AMD patient?

dark areas of elevation

What will serous RPE/retinal detachments look like on OCT of an AMD patient?

-Lipofuscin

-Hyperautofluorescence/Hypoautofluorescence

When imaging a patient with AMD, what should we look for on FAF?

lipofuscin collects in RPE cells that are functioning abnormally

What is lipofuscin and why can we see it on FAF of AMD patients?

poorly functioning RPE

What hyperautofluoresces on FAF?

missing RPE (dropout/window defects)

What hypoautofluoresces on FAF?

Maybe -- it is highly variable

Does MPOD correlate with development and progression of AMD?

maybe

Does dark adaptometry correlate with development and progression of AMD?

No

Is genetic testing recommended for patients with AMD?

No

IS skin carotenoid testing recommended for patients with AMD?

Indocyanine green angiography (ICG) & OCT-EDI (enhanced depth imaging)

Imaging of the choroid can be improved with _________

Yes, can be used to assess the choroid/choriocapillaris and outer retina

Can OCT-A be used for testing AMD patients? How?

-vit C

-vit E

-beta carotene

-Zinc

-Copper

What did the AREDS1 supplement contain?

Intermediate or worse AMD

Who benefitted from the ARED1 supplement?

No

Did patients with mild AMD benefit from AREDS1 supplement?

higher dietary carotenoids

What benefited ALL AMD patients in any stage of the disease?

Smokers (past smokers, heavy passive/second hand smokers)

_______ had a higher risk of lung cancer with the AREDS1 formula

attributed to the beta carotene

Why did Smokers (past smokers, heavy passive/second hand smokers) have an increased risk of lung cancer with the AREDS1 formula?

False

True or False:

The AREDS2 trial included patients with mild forms of AMD

No -- none of these additions had any benefit

Did lutein, zeaxanthin, or omega-3 fatty acids being added to the original AREDS1 supplement have any benefit?

Lutein and zeaxanthin

Betacarotene in the original AREDS1 supplement was replaced with what d/t having more benefit?

No -- there was no evidence of benefitting these patients

Overall, should AREDS1 or AREDS2 supplements be prescribed to patients with mild AMD or prophylactically?

No

Is there any study that has tested the benefit of AREDS supplementation prophylactically or in mild AMD?

contact the patient's physician

What do you have to do BEFORE prescribing a supplement for AMD?

-discuss smoking cessation if relevant

-discuss diet (green leafy vegetables, colorful fruit, omega-3 fatty acids as in fish, reduction of saturated fats)

-Discuss exercise

-Discuss weight loss if relevant

-Discuss UV protection

-All patients with the AMD dx receive an Amsler grid

-Fundus photography

What needs to be done FOR EVERY PATIENT with AMD?

small drusen with a few intermediate drusen

REVIEW: What is the characteristics of early AMD?

1 year

Early AMD Follow up schedule?

No associated "dramatic findings" (MPOD, autofluorescence, dark adaptation, skin carotenoids), normal BMI, diet, non-smoker

9 months

Early AMD Follow up schedule?

One associated "dramatic" abnormal finding, normal BMI and diet, nonsmoker

9 months

Early AMD Follow up schedule?

Normal findings, BMI high or poor diet, non-smoker

6 months

Early AMD Follow up schedule?

One associated "dramatic" abnormal finding, BMI too high or poor diet, non smoker

6 months

Early AMD Follow up schedule?

Smoker

Supplement

Intermediate AMD Follow up Schedule?

At this level, all patients will get prescribed what?

Some sort of imaging (OCT/FAF)

Intermediate AMD Follow up Schedule?

You must do what for these patients?

Referral or a short (4 month) F/U

Intermediate AMD Follow up Schedule?

If the testing is dramatically worse than expected or there is a serous detachment, what should be considered?

yes

Intermediate AMD Follow up Schedule?

Should all of these patients get an Amsler grid?

Yes

Intermediate AMD Follow up Schedule?

Should you do fundus photography on these patients?

Refer them all

Advanced AMD Follow up Schedule?

How should you manage these patients?

yes

Advanced AMD Follow up Schedule?

Should you prescribe these patients supplements?

anti-VEGF meds

What is the first-line ophthalmological treatment of wet AMD?

-Lucentis

-Avastin

-Eyelea

-Vabysmo

What are the most popular anti-VEGF injections?

That Lucentis and Avastin had similar efficacy in treating WET AMD

What did the CATT study demonstrate?

targets 2 inflammatory markers (Anti-VEGF and Angiopoietin-2)

What is the MOA of Vabysmo?

maybe

Can Vabsymo be injected less often than Eyelea?

Yes -- but they do not completely stop the progression or reverse the disease

Are there now intravitreal injections that slow the progression of geographic atrophy?

OCT-A

Pachychoroidal diseases can be differentiated with what tool?

-Dilation of choroidal vessels in Haller's layer

-Thinning of choriocapillaris and Sattler's layer

-Hyperpermeable vessels in Haller's layer and choroidal filling defects (reduced perfusion)

What is the issue associated with Pachychoroidal diseases?

-RPE abnormalities (RPE pigmentary changes)

-photoreceptor abnormalities

Pachychoroidal diseases may be associated with what?

OCT-A

______ can be useful in differentiating the different pachychoroidal diseases

Some lead to neovasc and some do not

Why would we want to differentiate the different pachychoroidal diseases?

-PDT

-Anti-VEGF meds

-or both

What may be applied in order to treat pachychoroidal disease?

serous retinal detachment

Central serous chorioretinopathy will typically involve a ________

Central Serous Chorioretinopathy (Pic)

Central Serous Chorioretinopathy (Pic)

large

Pachyvessels will be (small/large) in Central Serous Chorioretinopathy?

-Aneurysms on choroidal vessels

-Subretinal Fluid/RPE Detachment

What are the defining characteristics of Polypoidal choroidal vasculopathy/aneurysmal Type 1 Neovascularization (PCV/AT1)?

Polypoidal choroidal vasculopathy/aneurysmal Type 1 Neovascularization (PCV/AT1) (see pic)

Polypoidal choroidal vasculopathy/aneurysmal Type 1 Neovascularization (PCV/AT1) (see pic)

Hypoperfusion syndrome

______ is possible precursor to the ocular ischemic syndrome (OIS)

-dull ache in or around the eye

-TIA symptoms

-light induced amaurosis fugax

-carotid bruit

-decreased carotid pulse

What are the systemic findings of Hypoperfusion syndrome?

-unilateral venous dilation

-arterial narrowing

-venous beading

-non-tortuous vessels

-mid peripheral hemes

-possible retinal emboli

What are the ocular findings of Hypoperfusion syndrome?

Hypoperfusion + Signs of Hypoxia-Induced Inflammation

What is Ocular Ischemic Syndrome (OIS)?