Common Ocular Pathologies

Age-related macular degeneration (AMD) is the leading cause of irreversible central vision loss in adults over 50 in developed countries. It affects the macula — the central retina responsible for fine detail and color vision — while peripheral vision is typically preserved. Two forms exist: Dry (non-exudative) AMD accounts for ~85-90% of cases and is characterized by drusen (yellow lipid deposits beneath the RPE) and progressive RPE atrophy, including geographic atrophy in advanced stages. Progression is gradual over years. Wet (exudative/neovascular) AMD accounts for ~10-15% of cases but causes the majority of severe vision loss. It is defined by choroidal neovascularization (CNV) — abnormal vessel growth from the choroid through Bruch's membrane — leading to subretinal fluid, hemorrhage, and eventual disciform scarring. Patients may report sudden central blur, metamorphopsia (straight lines appearing wavy on Amsler grid testing), or a central scotoma. Risk factors: age >50, smoking (2-3x risk), Caucasian ethnicity, family history, hypertension, and obesity. Workup includes dilated fundus exam, OCT (gold standard for fluid detection), and fluorescein angiography for active CNV. Treatment: AREDS2 vitamin formulation slows progression of intermediate dry AMD; intravitreal anti-VEGF injections (ranibizumab, aflibercept, bevacizumab, faricimab) are the standard of care for wet AMD.