Consider AMD mimics to avoid misdiagnosis, unnecessary treatment

Key takeaways:

• Multimodal imaging can help distinguish AMD from other retinal pathologies.
• OCT angiography can help identify common mimics.

ORLANDO — Ophthalmologists must take measures to avoid misdiagnosing age-related macular degeneration and consider mimics of the disease, according to a speaker at Telling It Like It Is.

“Sometimes, if you’re in a busy clinic, it can be really difficult to establish if a patient has AMD or not, and sometimes they have AMD and another macular condition,” Jaclyn L. Kovach, MD, FASRS, of Bascom Palmer Eye Institute, said. “But you really want to work hard to try to establish their diagnosis because you don’t want to miss a treatable condition, and you don’t want to treat someone needlessly.”

According to Kovach, the presence of a small number of drusen is common as patients age and does not mean that they have macular degeneration. Therefore, it is key to distinguish between different types of drusen, including reticular pseudodrusen, which are present between the retinal pigment epithelium and the photoreceptor layer, and cuticular drusen, which have a “starry sky” appearance on fluorescein angiography and a sawtooth configuration.

Kovach said to look for large “lacy” areas of macular neovascularization without overlying fluid or hemorrhage to diagnose non-exudative neovascular AMD.

“We just monitor these patients and only treat if fluid exudation develops,” she said.

OCT angiography can be helpful with common AMD mimics, including central serous chorioretinopathy, which is indicated by pigment epithelial detachment, subretinal fluid and intraretinal fluid, and macular telangiectasia types 1 and 2.

“You want to avoid missing a treatable condition or treating someone needlessly,” she said. “The way to do this most effectively is using multimodal imaging.”

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Sources/Disclosures

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Source:

Kovach JL. Is this really AMD? Presented at: Telling It Like It Is; Feb. 13-16, 2025; Orlando, Florida.

Disclosures:
Healio could not confirm relevant financial disclosures at the time of publication.

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