Dry AMD
Symptoms
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Patients may be asymptomatic but others complain of a gradual reduction in detailed central vision. This may be severe.
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There may be mild associated distortion of vision, eg straight lines appearing slightly wavy.
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Patients may notice a shadow in their central vision (scotoma) that makes it difficult to read or to make out details on people's faces.
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They may have difficulty with tasks such as threading a needle.
Signs
Reduced visual acuity. This tends to be more pronounced for reading than for distance vision.
On direct ophthalmoscopy, you should get the patient to try to look at the light shining into their eye in order to direct this light at the macula. In dry AMD there are pigmentary changes on the macula. These tend to be a mixture of dark and light changes. There are often drusen (yellow, white deposits) on the macula. These may be small and hard or large and soft.
Wet AMD
Symptoms
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Sudden, painless reduction in central visual acuity.
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Faces may be more difficult to see clearly and reading may be more difficult with the affected eye.
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Marked distortion of central vision.
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The patient may complain that things that they know are straight, such as the skirting board, or blinds, or window frames or picture frames, appear to be kinked.
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Rarely, floaters may be present (if there is a significant associated vitreous haemorrhage). Presence of a central scotoma, the size of which may correspond to the size of the lesion.
Signs
Reduced visual acuity. There may be drusen, swelling and haemorrhage at the macula. The haemorrhage may be on the surface of the retina or below it. You may be able to see a greyish membrane at the macula.
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