Optometrists and ophthalmologists, with assistance from ophthalmic assistants, technicians and nurses, should carefully screen patients who are at risk for macular degeneration. These include patients older than 60; patients with hypertension or cardiovascular disease; cigarette smokers; patients with a first-degree family (sibling or maternal) history of vision loss from ARMD regardless of age; patients with aphakia or pseudophakia; or someone with a cataract, and patients with a history that indicates significant cumulative light exposure.
The ophthalmic assistant will take a careful history and log these risk factors. The patient then should have a complete ocular examination. Vision tests, performed by the physician or a skilled ophthalmic assistant, examine best corrected visual acuity, as well as near monocular visual acuity; refraction; biomicroscopy; tonometry; and stereoscopic fundus examination with pupillary dilation. Though rarely used even if ARMD is suspected, a central 10-degree computerized automated perimetry might be utilized along with fundus photography and laser ophthalmoscope scanning.
After preliminary testing, specific tests are performed to determine macular degeneration. To make the diagnosis, the doctor dilates the pupil with eye drops and examines the interior of the eye, examining the retina for the presence of drusen, small white-yellow spots in the macular area, and for gross changes in the macula such as thinning. The doctor also administers a visual field test to search for blank spots in the central vision. The doctor might order fluorescein angiography (intravenous injection of fluorescent dye followed by visual examination and photography of the back of the eye) to determine if blood vessels in the retina are leaking. Retinal pigmented epithelium (RPE) mottling that occurs, like the drusen, due to ateriorsclerotic changes of the macula decreasing the blood supply, can also be indicated through a thorough examination.
A central visual field test called an Amsler grid is usually given to patients who are suspected of having ARMD. It is a grid printed on a sheet of paper (also presented for home use every week). When viewing a central dot on the page, the patient should note if any of the lines appear to be wavy or missing. This could be an indication of fluid and the onset of wet ARMD. High-risk patients particularly will be urged to schedule more frequent checkups.
Although ophthalmologists and optometrists can accurately diagnose macular degeneration, attending physicians may want to consult with a retinal specialist for the best treatment protocols.
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