Is high-resolution OCT as good as FFA at detecting treatable wet AMD?

Can modern high-resolution OCT alone provide sufficient information on which to base a decision to treat?

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Age-related macular degeneration (AMD) is responsible for 57.2% of all blind and 56% of all partial-sight registrations in England and Wales (Bunce & Wormald 2006). This condition is primarily one of old age (people over 60 years of age) and it destroys the central discriminating part of vision, thus destroying the ability of the sufferer to see detail – faces, television, text. This has a major impact on the quality of life of the sufferer, quite apart from the social and medical costs of the care such people require for the remainder of their lives (Brody et al. 2001). There are two forms of the disease. The dry form is a relatively slow degenerative condition in which the retinal pigment epithelium (RPE) at the outer portion of the retinal structure atrophies with attendant loss of vision in that area. The wet form of the disease can be a rapidly developing condition where aberrant new blood vessels lying underneath the RPE rupture the RPE and leak fluid (blood, plasma and protein) into the retinal structures. This fluid causes distortion in the vision, resulting in lines of print appearing wavy and recognition of faces becoming difficult, as if looking through distorting glass. This fluid can cause irreparable scarring within days if left untreated and therefore prompt assessment of patients who present with a loss of central vision is critical if there is to be any chance of retarding the progression of their disease. According to the National Institute for Health and Clinical Excellence (NICE), there are about 26 000 new cases of wet AMD in the UK each year (NICE 2008).

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