Skill Checkup: A 61-Year-Old Man With Central Visual Acuity Blurring

F. Ryan Prall, MD


September 24, 2021

On fluorescein angiography, findings that suggest exudative AMD (advanced neovascular AMD) include increasing hyperfluorescence secondary to dye leakage from the CNV and hypofluorescent blockage from subretinal hemorrhage. More generally, dry AMD can be distinguished from wet AMD in patients that do not have exudation of fluids from blood vessels. In advanced disease, also called "late dry" AMD, geographic atrophy of the RPE becomes advanced.

Non-neovascular AMD, or nonexudative (dry) AMD, often does not progress further than pigment discoloration and drusen development. About 90% of patients with AMD have this form; additionally, nearly everyone older than 50 years has at least one small druse. However, approximately 20% of patients with nonexudative AMD progress to the exudative form. Generally, loss of vision from nonexudative AMD progresses much more slowly (over decades) than exudative AMD (over months). In exudative AMD, CNVM develop under the retina and can leak fluid and blood and, if left untreated, ultimately causes a centrally blinding disciform scar.


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