Age-Related Macular Degeneration Preferred Practice Pattern ®
Age-Related Macular Degeneration Preferred Practice Pattern®
Background: Age-related macular degeneration is a leading cause of severe, irreversible vision impairment in developed countries. The primary risk factors for the development of advanced AMD include increasing age, northern European ancestry, and genetic factors. Smoking has been shown by numerous studies to be the main modifiable risk factor.
This Preferred Practice Pattern (PPP) uses the classification of the Age-Related Eye Disease Study (AREDS) and a more recent clinical classification to define the early and intermediate stages of AMD since current treatment recommendations are based on these classifications. The PPP recommendations are based on Cochrane-identified reliable systematic reviews.
Rationale for treatment: Prospective randomized controlled clinical trials support the use of antioxidant vitamins and minerals for slowing the progression to later stages of AMD, intravitreal injection of anti-VEGF agents, photodynamic therapy (PDT), and laser photocoagulation surgery to treat neovascular AMD. It should be noted that intravitreal injection therapy using anti-vascular endothelial growth factor (VEGF) agents (e.g., aflibercept, bevacizumab, and ranibizumab) is the most effective way to manage neovascular AMD and represents the first line of treatment.
Care Process: Patient outcome criteria are to reverse or minimize visual loss and improve visual function. The initial evaluation of a patient with signs and symptoms suggestive of AMD includes all features of the comprehensive adult medical eye evaluation, with particular attention to those aspects relevant to AMD. In patients with neovascular AMD, early detection and prompt treatment improves the visual outcome. Symptoms suggestive of postinjection endophthalmitis or retinal detachment require prompt evaluation.
Fundus fluorescein angiography and optical coherence tomography (OCT) are useful diagnostic tests in clinical practice to detect new or recurrent neovascular disease activity and guide therapy.
Management options for AMD include observation and early detection, antioxidant vitamin and mineral supplements, intravitreal injection of anti-VEGF agents, PDT, laser photocoagulation surgery, and the encouragement of smoking cessation for patients who currently smoke. All patients with AMD should be educated about the prognosis of the disease and the potential value of treatment as appropriate for their visual and functional status.
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