Diagnosis of Age-related macular degeneration
Diagnostic Test list for Age-related macular degeneration:
The list of medical tests
mentioned in various sources as
used in the diagnosis of Age-related macular degeneration
includes:
Age-related macular degeneration Diagnosis: Book Excerpts
Tests and diagnosis discussion for Age-related macular degeneration:
Are You at Risk for Age-Related Macular Degeneration: NEI (Excerpt)
Your eye care professional may suspect AMD if you are over age 60
and have had recent changes in your central vision. To look for
signs of the disease, he or she will use eye drops to dilate, or
enlarge, your pupils. Dilating the pupils allows your eye care
professional to view the back of the eye better.
You may also be asked to view an Amsler grid, a pattern that
looks like a checkerboard. Early changes in your central vision will
cause the grid to appear distorted, a sign of AMD. (Source: excerpt from Are You at Risk for Age-Related Macular Degeneration: NEI)
Facts About Age-Related Macular Degeneration: NEI (Excerpt)
Eye care professionals detect AMD during an eye examination that
includes:
Visual acuity test: This eye chart test measures how well
you see at various distances.
Pupil dilation: This examination enables your eye care
professional to see more of the retina and look for signs of AMD. To
do this, drops are placed into the eye to dilate (widen) the pupil.
After the examination, your vision may remain blurred for several
hours.
One of the most common early signs of AMD is the presence of
drusen. Drusen are tiny yellow deposits in the retina. Your
eye care professional can see them during an eye examination. The
presence of drusen alone does not indicate a disease, but it might
mean that the eye is at risk for developing more severe AMD.
While conducting the examination, your eye care professional may
ask you to look at an Amsler grid. This grid is a pattern
that resembles a checkerboard. You will be asked to cover one eye
and stare at a black dot in the center of the grid. While staring at
the dot, you may notice that the straight lines in the pattern
appear wavy to you. You may notice that some of the lines are
missing. These may be signs of wet AMD (See Amsler Grid
below.)
If your eye care professional suspects you have wet AMD, you may
need to have a test called fluorescein angiography. In this
test, a special dye is injected into a vein in your arm. Pictures
are then taken as the dye passes through the blood vessels in the
retina. The photos help your eye care professional evaluate leaking
blood vessels to determine whether they can be treated. (Source: excerpt from Facts About Age-Related Macular Degeneration: NEI)
Diagnostic Tests for Age-related macular degeneration: Online Medical Books
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for more information about diagnostis of Age-related macular degeneration.
SCOTOMA:
Ask the Following Questions:
(Algorithmic Diagnosis of Symptoms and Signs)
- Is it transient? If the scotomas are transient, then migraine, transient ischemic attacks, and retrobulbar neuritis should be suspected.
- Are there abnormalities on the eye examination other than the optic nerve? On a careful eye examination, the clinician may find corneal opacities, muscae volitantes, cataracts, choroiditis, glaucoma, retinitis, retinal hemorrhage, and detached retina.
- Are there other neurologic signs? The presence of other neurologic signs may suggest multiple sclerosis, carotid artery thrombosis or insufficiency, basilar artery thrombosis or insufficiency, and pseudotumor cerebri, among other disorders.
DIAGNOSTIC WORKUP
This should include a careful eye examination with slit lamp, tonometry, and visual field examinations. If the initial findings suggest an ocular disorder, referral to an ophthalmologist should be made. If the neurologic examination is abnormal, the patient should be referred to a neurologist, rather than ordering expensive tests such as a CT scan, MRI scan, VEP studies, angiography, and spinal fluid examinations.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Scotoma:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
First, identify and characterize the scotoma, using such visual field tests as the tangent screen examination, the Goldmann perimeter test, and the automated perimetry test. Two other visual field tests — confrontation testing and the Amsler grid — may also help in identifying a scotoma.
Next, test the patient’s visual acuity and inspect his pupils for size, equality, and reaction to light. An ophthalmoscopic examination and measurement of intraocular pressure are necessary.
Explore the patient’s medical history, noting especially eye disorders, vision problems, or chronic systemic disorders. Find out if he takes medications or uses eyedrops.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Age-related macular degeneration:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
❑ Indirect ophthalmoscopy — fundus examination through a dilated pupil may reveal gross macular changes.
❑ I.V. fluorescein angiography — sequential photographs may show leaking vessels as fluorescein dye flows into the tissues from the subretinal neovascular net.
❑ Amsler’s grid — used to monitor visual field loss.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Scotoma:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
First, identify and characterize the scotoma, using such visual field tests as the tangent screen examination, the Goldmann perimeter test, and the automated perimetry test. Two other visual field tests—confrontation testing and the Amsler grid—may also help in identifying a scotoma.
Next, test the patient’s visual acuity and inspect his pupils for size, equality, and reaction to light. An ophthalmoscopic examination and measurement of intraocular pressure (IOP) are necessary.
Explore the patient’s medical history, noting especially any eye disorders, vision problems, or chronic systemic disorders. Find out if he takes medications or uses eyedrops.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Scotoma:
History
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A. Nature of the scotoma. Try to establish whether the field loss is monocular or binocular. Binocular scotomas, which imply chiasmal or posterior chiasmal lesions, are vascular (stroke, transient ischemic attack, migraine, ruptured arteriovenous malformation) or compressive in nature (pituitary mass, meningioma, glioma). Establish with the patient the location of the defect. Scotomas that migrate through the visual field include vitreous floaters, vitreous hemorrhage, scintillating scotoma of migraine, and so forth. An altitudinal field loss is likely a prechiasmal lesion [i.e., optic nerve disease (e.g., ischemic optic neuropathy, glaucoma) or retina disease (e.g., detached retina, retina vascular occlusion)]. Central scotomas are commonly seen in optic nerve and macular lesions with macular degeneration by far the most common in the elderly. Macular holes, optic neuritis, toxic or metabolic optic neuropathy, central serous choroidopathy, maculopathy secondary to medications (hydroxychloroquine, thioridazine, chlorpromazine, quinine, tamoxifen), and others are examples of macular-induced central scotomas. Peripheral vision loss, if bilateral and homonymous, indicates a stroke opposite the side of field loss. Tumors, arteriovenous malformations, and migraines can cause hemianopias. Glaucoma, detached retina, retinitis pigmentosa, chronic papilledema, and previous laser treatment for diabetes are also common entities affecting peripheral vision.
B. Onset and timing of scotoma. A scotoma of sudden onset will be secondary to some kind of vascular event: embolic, hypoperfusion, inflammatory, or hemorrhagic. Transient vision loss lasting seconds can occur with temporal arteritis, papilledema, or vertebrobasilar insufficiency. Visual loss lasting minutes to hours occurs in temporal arteritis or amaurosis fugax. Visual changes lasting weeks to months represent retinal vein occlusion, expanding compressive lesion, papilledema, and if associated with pain on eye movement, optic neuritis. Gradual progressive visual field loss occurs with compressive masses; however, acute expanding lesions from infectious, inflammatory (e.g., sarcoid, Tolosa-Hunt), aneurysmal, or apoplexy of a pituitary mass can cause rapid vision loss. Monocular vision loss after head trauma suggests injury to the intracanalicular portion of the optic nerve, compressive fracture of the sphenoid bone, or edema to the optic nerve. Emergent computed tomography (CT) scan with neurosurgical or ophthalmic consultation and high-dose intravenous steroids are needed.
C. Associated symptoms. The presence of neurologic signs or symptoms can localize the area of the pathology. Amaurosis fugax implies ipsilateral internal carotid disease or cardiac disease. History of vertigo, diplopia, and urinary incontinence in a young patient with a monocular central scotoma implies multiple sclerosis. Older patients with acute monocular vision loss associated with periorbital pain and headaches, fatigue, jaw claudication, or muscle aches strongly suggests temporal arteritis. Transient dimming or loss of vision in one or both eyes with orthostatic changes can be seen with papilledema of intracranial hypertension. Progressive monocular visual loss with proptosis obviously implies an orbital mass (optic nerve glioma, meningioma, cavernous hemangioma), but asymmetric thyroid-related orbitopathy can present a similar picture. Monocular loss progressing over time without orbital signs can be seen with an intracanalicular or intracranial optic nerve mass.
D. Past medical and social history. Diabetes and hypertension are the two most common causes of ischemic optic neuropathy (ION). ION presents as a sudden painless monocular vision loss, altitudinal in nature, with an APD. The risk of retinal vascular occlusions is much greater in patients with diabetes mellitus or hypertension. The risk is greater with tobacco use. A history of rheumatic fever, heart murmur, or cardiomyopathy is significant for an embolic source. Sudden vision loss without an APD in a diabetic patient is most likely a vitreous hemorrhage. An acquired immunodeficiency syndrome patient with a CD4 count less than 50 × 103 with visual scotomas needs to be evaluated for cytomegalovirus retinitis. A history of alcohol abuse or a psychiatric patient with bilateral vision loss and change in mental status needs urgent chemistries for anion gap acidosis with hemodialysis if methanol ingestion is suspected. An intravenous drug user can suffer a vascular occlusion from talc.
Physical examination
A. Visual acuity. The vision of each eye should be assessed with spectacles or contact lenses in each eye independently. Central scotomas are seen with optic nerve, macular disease, or (rarely) an occipital tip lesion; and Snellen visual acuity will be decreased.
B. Visual fields. Confrontation field test is performed with each eye independently. Briefly flash several fingers in each of the four quadrants. Bilateral field loss in the same field of vision in each eye indicates injury posterior to the chiasm. Bitemporal field defects are seen with chiasmal lesions (pituitary masses, craniopharyngiomas, and others). Monocular field defects are seen in retina and optic nerve disease.
C. Pupil examination. The presence of a prominent APD, which implies optic nerve injury, will help to differentiate central scotomas caused by macular disease. An APD is commonly seen with optic neuritis, optic neuropathy (ischemic and traumatic), asymmetric glaucomatous damage, optic nerve tumors, and central retinal artery or vein occlusion. An APD is not seen in early papilledema and minimally with macular degeneration, macular holes, or choroidopathy.
D. Fundus examination. Direct ophthalmoscopy can give a quick assessment of the red reflex (i.e., a dim red reflex in a diabetic with vitreous hemorrhage). Vitreous floaters can occasionally be seen as shadows in the red reflex. Examine the nerve for edema, pallor, or glaucomatous cupping. Macular scarring or pigmentary change is most commonly seen with macular degeneration.
E. Other examinations. A neurologic assessment is needed for a patient with bilateral field loss, screening for contralateral paresis and other focal deficits, palpation of the temporal artery for tenderness or diminished pulse if the history suggests giant cell arteritis, as is auscultation of the carotids for bruits and the heart for a murmur in a patient with amaurosis fugax or stroke. Glaucoma can be screened with tonometry. Check arms and legs for signs of intravenous drug abuse.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Retinal Phenomena:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Hypertension
❑ Diabetic retinopathy
❑ Glaucoma
❑ Cholesterol emboli
❑ Papilledema
❑ Pigmented crescent
❑ Macular degeneration
❑ Retinal detachment
❑ Acute optic neuritis
❑ Optic atrophy
❑ Retinal hemorrhage
❑ Chorioretinal exudates
❑ Lipemia retinalis
❑ Central retinal artery occlusion
❑ Central retinal vein occlusion
❑ Angioid streaks
❑ Hyperviscosity
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Macular degeneration:
Diagnosis
(Handbook of Diseases)
The following tests are used to diagnose macular degeneration:
❑ indirect ophthalmoscopy: may reveal gross macular changes
❑ Amsler’s grid: reveals central visual field distortion
❑ I.V. fluorescein angiography: may show leaking vessels as fluorescein dye flows into the tissues from the subretinal neovascular net.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Scotoma:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Explore the patient’s medical history, noting especially any eye disorders, vision problems, or chronic systemic disorders. Find out if he takes medications or uses eyedrops.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Scotoma:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Explore the patient's medical history, noting especially eye disorders, vision problems, or chronic systemic disorders. Find out if he takes medications or uses eyedrops.
Identify and characterize the scotoma, using such visual field tests as the tangent screen examination, the Goldmann perimeter test, and the automated perimetry test. Two other visual field tests—confrontation testing and the Amsler grid—may also help in identifying a scotoma.
Next, test the patient's visual acuity and inspect his pupils for size, equality, and reaction to light. An ophthalmoscopic examination and measurement of intraocular pressure are necessary.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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