Mayo Clinic: Macular Degeneration Treatment

New Jersey Medical School Center for Macular Degeneration Treatment and Research: Macular Degeneration Clinical Research

Despite a growing interest in AMD the options for treatment remain limited. Treatment is mainly targeted at the neovascular form of the disease using laser photocoagulation.

The value of routine screening, given the lack of effective treatment, is unproven. There maybe a case for self assessment using an Amsler Grid in those patients with high risk of neovascular disease, which includes those with large soft drusen and pigment hyperplasia and those with established exudative AMD in one eye. Mild low risk disease (ARM) requires no special management and, coming on slowly, can be managed in the community. Optometrists would seem to be well placed to carry out routine examinations and offer advice about the value of magnification and lighting.

Optometrists can reassure patients with minimal symptoms or signs of ARM and should not refer further. Referral is indicated when:

• There is rapidly developing visual failure but still reasonable vision suggestive of exudative disease that might benefit from urgent assessment and laser treatment.
• There is significant visual loss needing accurate diagnosis.

There is significant visual loss needing partially sighted or blind registration.General practitioners and Today, optometrists need to be aware of the urgent nature of referrals forpatients with recent onset of distortion and visual loss (less than a month) and who still havereasonably good vision (6/12 or better). Such patients may still have treatable disease and should be referred urgently to either the ophthalmic casualty department or to the out patient clinic following discussion with the local ophthalmologist. This is particularly true for the second eye when the other eye is already involved.

In the elderly population with AMD, concurrent ophthalmic disease, such as cataract and glaucoma may also frequently occur and needs to be identified and treated appropriately.The management pathway will involve the following stages and it is important that theresources and personnel to achieve these are properly funded:

1. Diagnosis and assessment of macular disease including angiography and exclusion of othertreatable causes of visual failure.

2. Treatment by laser photocoagulation or otherwise as appropriate.

3. Rehabilitation including provision of suitable optical aids in the primary or secondary sector and training in their use, and
counselling and rehabilitation within the hospital and statutory or voluntary servicesin the community.

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