No abstract

Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss in people over the age of 50 years in Australia. Optometry Australia has developed this AMD chairside reference in consultation with a member-based working group comprised of experienced practitioners. It provides an evidence-based approach to current best practice in the diagnosis and management of AMD. Optometrists should be competent in assessing patients with or at risk of developing AMD, so that they are able to provide evidence-based management including appropriate communication, diagnosis and referral when indicated. This AMD chairside reference covers risk factors for the development of AMD or progression to late-stage AMD; the current clinical classification of AMD; common signs and symptoms; optometric assessment including ocular imaging and biomarkers; differential diagnoses; and management of early, intermediate and late AMD. Optometry Australia's chairside reference is intended as a general guide for optometrists, and is not a formal management protocol.

Purpose: Recent evidence suggests several macular diseases are associated with peripheral retinal changes. This study investigated the number, type and management consequences of peripheral retinal findings detected in patients attending a referral only, eye-care clinic, the Centre for Eye Health(CFEH) with macular disease. Methods: Records of 537 patients attending CFEH for a macular assessment were included in the study. Subjects were classified as having age-related macular degeneration (AMD), epiretinal membrane (ERM), central serous chorioretinopathy (CSCR), inherited macular dystrophy or no macular disease. Data extracted included reason for referral, macular findings, peripheral findings (based on examination by ultra-widefield scanning laser ophthalmoscopy), diagnosis and management. Results: After age-matching, the number of peripheral findings in subjects with AMD, ERM or CSCR was not significant different to normal subjects. The most common finding for all cohorts were non-specific, degenerative changes such as drusen or pigmentation (61-72%) except inherited macular dystrophy subjects who had mostly vascular findings (30%; p < 0.05). Subjects with AMD and ERM with peripheral findings were significantly more likely to be reviewed or referred to an ophthalmologist than discharged back to their community eye care provider compared to subjects without findings. However only 8% of subjects had altered management based specifically on peripheral findings suggesting the macular findings in most subjects dictated their management. For those with a change, it was significant (upgrade to referral to an ophthalmologist). Peripheral findings also flagged 5% of subjects with vascular findings for referral to their general practitioner (GP). Conclusions: Overall, the percentage and distribution of peripheral retinal findings in some macular diseases was similar to normal subjects. However, subjects with peripheral findings appeared to have significant differences in management. Considering some common findings, such as peripheral drusen may be relevant to AMD pathogenesis and therefore affect management of this disease, assessment of the peripheral retina should not be overlooked when the clinical focus is on the posterior pole.

Age-related macular degeneration (AMD) is one of the leading causes of blindness worldwide in the elderly population. Optometrists, as primary eye health care providers, require the skills and knowledge to accurately diagnose and manage AMD patients. There is an overwhelming body of research related to the clinical presentation, etiology, epidemiology, and pathology of this disease. Additionally, the evolution of new imaging modalities creates new opportunities to clinically detect and analyze previously uncharacterized and earlier changes in the retina. The challenge for optometrists is to combine all this information into an applicable knowledge base for use in everyday clinical assessment of AMD so that timely and accurate referrals can be made to retinal specialists. This review attempts to address this issue by linking the clinical presentation of AMD with the underlying disease biology. We emphasize the contribution of recent noninvasive imaging technologies to the clinical assessment of early and more advanced AMD including optical coherence tomography, fundus autofluorescence, and infrared reflectance.

Transient chromatic pattern visual evoked potentials (VEPs) have been found to be less repeatable in morphology in children than in adults at low to moderate chromatic contrasts. The purpose of this study is to investigate whether low repeatability of VEP components can be associated with high alpha power, in a comparison of alpha activity in children and adults. Transient chromatic contrast and achromatic resolution VEPs were recorded in children (n = 14, mean 9.6 years) and adults (n = 12, mean 21.8 years) with normal vision and assessed for repeatability. Isoluminant chromatic (magenta-cyan) and luminance-modulated achromatic grating stimuli were presented at and above psychophysical threshold levels, in pattern onset-offset at 2 Hz temporal frequency. EEGs (eyes closed and open) were recorded as single sweeps (1 s long) over three 30 s periods while facing a uniform computer display. An index of VEP detectability by observation was developed based on VEP component repeatability. The index was examined for correlations with alpha-wave parameters. Alpha power was calculated as the sum of the powers of 8-13 Hz frequencies of the EEG sweeps (using the discrete Fourier transform). Alpha power variability was calculated using the standard deviation of the powers of each sweep in a 30 s time period. The children had significantly higher alpha powers than the adults for both the eyes-open and eyes-closed conditions. Alpha power variability was significantly higher for the eyes-open condition only. There was no relationship between alpha power parameters and index of VEP detectability by observation for both the chromatic and achromatic grating stimuli. Poor repeatability of transient pattern VEPs is not associated with high alpha power or its variability in EEG measurements in older children or young adults at Oz.