Age-related Macular
degeneration
Assessment, referral and treatment
 Oxford, Stoke Mandeville  [Pick the date]
AMD Leaflet (Oxford)
NICE guidelines
 Age-related Macular degeneration
Age-related
Macular
degeneration
Assessment, referral and treatment
Introduction:
Age-related macular degeneration presents in patients
aged over 55 years of age, with reduced vision, or
distortion. Urgent assessment is required due to the
possibility of rapid progression of the disease.
Clinical examination +/- colour imaging and OCT
should allow appropriate diagnosis. If there is no
evidence of haemorrhage and no oedema on OCT
then patients should be advised to self monitor with
an Amsler chart each eye separately and to seek
review from the department within one week if they
notice any new distortion or deterioration in vision.
If you are unable to exclude CNV, refer to the AMD
retinal imaging clinic.
Patients should be advised to eat a balanced diet with
highly coloured vegetables (broccoli, spinach,
beetroot, peppers). Regular oily fish in the diet is
also of benefit. Vitamin supplementation is only of
benefit in those with drusen. In addition if they are
smokers they should be offered advice re help
available to stop smoking.
Wet AMD
First presentation:
For all new presentations of macular degeneration
you should determine if they have early AMD, dry /
geographic AMD or Wet AMD. If this cannot be
done clinically they require colour fundus
photography and OCT and referral within 1 -5 days
to the AMD clinic.
Early AMD but no CNV
Patients who present with evidence of CNV with
vision between 6/12 and 6/96 (NICE guidelines for
eligibility to NHS Lucentis treatment) require colour
fundus photography, OCT and FFA with referral to
the AMD clinic within 1-5 days.
Patients who present with evidence of CNV with
vision outside of the NICE guidelines should have
colour photography and OCT only with referral to
the AMD clinic within 2 weeks.
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 Age-related Macular degeneration
Geographic Atrophy
Geographic atrophy (GA) may progress resulting in
decreased vision +/- development of distortion. If the
level of vision is appropriate they may benefit from
low vision assessment.
Presentation of current AMD clinic
patient:
Presentation with altered vision or fresh
haemorrhage in either eye requires dilated fundus
examination, colour and OCT imaging. The images
can then be checked in the retinal imaging review
clinic.
Presentation post Lucentis treatment:
All patients undergoing Lucentis treatment who
present with altered vision or pain in the treated eye,
must be reviewed urgently the same day. They
require visual acuity, dilated fundus check. Raised
intraocular pressure, endophthalmitis, retinal
haemorrhage or a retinal pigment epithelial tear,
retinal detachment are all potential complications that
must be considered in these patients.
notes on to either the Medical Retina Fellow, or the
registrar attached to the firm.
Tuesday AM: Macular Clinic (Dr)
Patients referred with macular problems including
AMD, CSR, macular telengiectasia.
Tuesday and Thursday PM: Rapid Access
Clinic (Imaging and Dr)
With first presentation referred from GP or opticians
can be seen in this clinic within 1- 10 days of referral.
For urgent referrals – approach MR Fellows for
ad hoc advice.
Leaflets
All patients with a new diagnosis of wet AMD
requiring treatment should receive the AMD
information sheet. (Appendix 1)
Studies
IVAN (Oxford)
Evidence of progression of disease (fresh
haemorrhage, increased sub-retinal fluid) requires
colour photograph, OCT and referral within 1-5 days
to the AMD clinic.
AMD Clinic options:
Tuesday AM: Retinal imaging clinic
(Imaging Dept).
Virtual clinic – Patients’ colour OCT +/- FFA imaging
is reviewed from the previous week. Decision to
perform further imaging, see in clinic or commence
treatment is decided based on history and images. If
you require patients to be reviewed in this clinic
organise the appropriate imaging, and inform the
photographers that the patient needs to be added to
the retinal imaging review clinic. Pass the details and
This is a 2-year randomized controlled trial of
alternative treatments to inhibit VEGF in age related
macular degeneration (AMD). Lucentis (Ranibizumab)
and Avastin (Bevacizumab), 2 new drugs given as
intravitreal injections for wet AMD are being
compared for efficacy regarding treatment benefits,
duration of treatment and cost effectiveness. This
trial has been rolled out across 21 centres in the UK
and has finished recruiting. The results should
become available towards the end of 2011.
GAP and GATE - The natural history of
Geographic atrophy (dry AMD) progression
(Oxford)
These are two separate studies. GAP describes the
natural history and GATE is assessing response to a
novel treatment for geographic atrophy. As GA
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 Age-related Macular degeneration
progresses at different rates in different people; the
aim of this study is to gain a better understanding of
what influences its progression. The knowledge
gathered from this study will be added to existing
information already known about GA. The GATE trial
will assess response to treatment. Both trials have
completed recruitment.
AMD Leaflet Oxford (Links)
NICE Guidelines (Links)
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