13.1 Age-Related Macular Degeneration & Retinal Vascular Occlusions

AMD and Retinal Vascular Occlusions

Macular degeneration and vascular occlusion are common retina-clinic problems, but imaging findings must be interpreted with the history and examination. The technician's role is accurate acquisition, symptom recognition, documentation, and escalation.

Age-related macular degeneration

AMD affects the macula and is broadly described as non-neovascular or neovascular. Findings may include:

• drusen of different sizes and morphology;
• retinal pigment epithelial pigment change or migration;
• geographic or complete RPE and outer-retinal atrophy;
• intraretinal or subretinal fluid;
• subretinal hyperreflective material or neovascular tissue;
• hemorrhage, exudation, fibrosis, or pigment epithelial detachment.

OCT documents fluid compartments and structural change. Fundus photography supports comparison; FAF can map atrophy; fluorescein or ICG may answer vascular questions. A smooth serous PED can occur in several conditions. Overlying fluid or hemorrhage raises concern for activity, but the clinician determines whether the process is neovascular AMD, central serous chorioretinopathy, polypoidal disease, or another entity.

Ask about new distortion, central blur, scotoma, change in reading, and fellow-eye status. New symptoms are routed promptly. Do not tell the patient that one OCT proves the diagnosis or guarantees an injection.

Retinal vein occlusion

A branch retinal vein occlusion follows a branch distribution; a central retinal vein occlusion can produce widespread intraretinal hemorrhage, venous dilation and tortuosity, disc edema, cotton-wool spots, and macular edema. Visual acuity, RAPD, OCT, angiography, and anterior-segment examination help the clinician assess severity and risk.

Ischemia can lead to iris or angle neovascularization and neovascular glaucoma, but older labels such as 90-day glaucoma are not scheduling rules. Neovascularization can develop earlier or later. Follow-up frequency and gonioscopy are clinician-directed from the actual findings, not one fixed disc-area threshold or calendar interval.

The technician records pain, vision, pressure, pupil findings, prior injections or laser, and systemic vascular history. Unexpected pressure rise, corneal edema, iris vessels, or marked pain is escalated promptly.

Retinal artery occlusion

Central or branch retinal arterial occlusion commonly presents with sudden, painless monocular field or vision loss. Diffuse retinal whitening and a cherry-red fovea can appear in central occlusion; a cilioretinal artery may preserve a central island in some eyes. The ocular finding is also a marker of systemic vascular risk.

Current safe triage treats acute retinal arterial ischemia as an emergency requiring immediate stroke-system evaluation. Do not delay transfer for ocular massage or other unproven office maneuvers. Record exact last-known-well time, eye, symptoms, neurologic complaints, medications, and emergency routing.

In patients age 50 or older, ask and immediately relay symptoms of giant cell arteritis such as new headache, scalp tenderness, jaw claudication, fever, weight loss, or shoulder and hip aching. The emergency clinician may order inflammatory markers, platelet count, imaging, or treatment. The technician does not independently order or interpret those tests.

Imaging quality checklist

1. Confirm correct eye and scan or photographic field.
2. Center through pupil and avoid lid, lash, motion, and media artifacts.
3. Inspect OCT segmentation rather than trusting thickness maps alone.
4. Record dye timing and adverse symptoms for angiography.
5. Compare with the same prior protocol when possible.
6. Route a major new hemorrhage, fluid change, neovascular sign, or perfusion concern promptly.

Comparison table

Reliable data and fast routing matter more than a technician-applied label.

Technician observations and urgent routing

For AMD follow-up, acquire the ordered acuity and imaging with consistent device, scan pattern, centering, and registration when possible. Record new distortion, scotoma, hemorrhage symptoms, treatment interval, recent procedure, and adherence without labeling the lesion active or inactive. Segmentation error, poor signal, blink, motion, and decentration can simulate structural change; correct acquisition problems and preserve the original evidence when required.

Sudden painless monocular loss, an altitudinal or diffuse field complaint, or transient monocular blackout may represent arterial ischemia and requires immediate emergency routing under the stroke pathway. A vein occlusion can also present abruptly, but a technician cannot distinguish the vascular diagnosis by symptoms alone. Do not delay emergency evaluation for office maneuvers or promise that massage, pressure lowering, oxygen, or a later clinic visit will restore vision. Ask about neurologic symptoms and, when relevant, giant-cell-arteritis warnings, then relay the answers directly to the clinician or emergency team.