Latowsky M L
Department of Family and Community Medicine, University of Toronto, Ont.
CMAJ. 1988 Dec 1;139(11):1053-8.
Age-related macular degeneration (ARMD) is the most common cause of blindness in Canada, and, as the name suggests, its incidence increases rapidly with age. Atrophic maculopathy, one of the forms of ARMD, is associated with only mild to moderate visual loss but is not treatable. On the other hand, exudative maculopathy, another form, is characterized by the formation of neovascular membranes and causes acute visual disturbances; however, it is potentially treatable by means of laser photocoagulation. In symptomatic patients blood, lipids or serous fluid seen on funduscopic examination indicates occult neovascularization, even if no neovascular membrane is visible. In asymptomatic patients their age, the presence of soft drusen and the coarse pigmentary disturbance have the greatest correlation with the risk of neovascularization. Suitability for laser photocoagulation depends on the stage of exudative maculopathy, the duration of symptoms and the patient's visual acuity. Therefore, family physicians must know what the earliest symptoms are and how to identify patients at highest risk so that intervention in terms of education, screening and prompt referral to an ophthalmologist for confirmation and subsequent treatment can be instituted.
年龄相关性黄斑变性（ARMD）是加拿大失明的最常见原因，顾名思义，其发病率随年龄迅速增加。萎缩性黄斑病变是ARMD的一种形式，仅与轻度至中度视力丧失相关，但无法治疗。另一方面，渗出性黄斑病变是另一种形式，其特征是新生血管膜的形成，并导致急性视力障碍；然而，它可以通过激光光凝治疗。在有症状的患者中，眼底检查所见的血液、脂质或浆液表明存在隐匿性新生血管形成，即使没有可见的新生血管膜。在无症状的患者中，他们的年龄、软性玻璃膜疣的存在以及粗糙的色素紊乱与新生血管形成的风险相关性最大。激光光凝的适用性取决于渗出性黄斑病变的阶段、症状持续时间和患者的视力。因此，家庭医生必须了解最早的症状是什么，以及如何识别风险最高的患者，以便在教育、筛查方面进行干预，并及时转诊至眼科医生处进行确诊和后续治疗。
