Age-Related Macular Degeneration
HIGHLIGHTED FINDINGS AND RECOMMENDATIONS FOR CARE
The primary risk factors for the development of advanced AMD include increasing age, northern European ancestry, and genetic factors. Cigarette smoking is the main modifiable risk factor that has been consistently identified in numerous studies. Smoking cessation is strongly recommended when advising patients who have AMD or are at risk for AMD. The routine use of genetic testing is not recommended at this time.
A meta-analysis of 10 studies found that the use of aspirin was not associated with an increased risk of AMD. Therefore, patients who have been instructed by a physician to use aspirin should continue to use it as prescribed.
Antioxidant vitamin and mineral supplementation as per the Age-Related Eye Disease Study (AREDS2) should be considered in patients with intermediate or advanced AMD. There is no evidence to support the use of these supplements for patients who have less than intermediate AMD and no evidence of any prophylactic value for family members without signs of AMD.
Fluorescein angiography, optical coherence tomography (OCT), and optical coherence tomography angiography (OCTA) are useful diagnostic tests in clinical practice to detect new or recurrent neovascular disease activity and guide therapy.
In patients with neovascular AMD, early detection and prompt treatment improves the visual outcome. 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. Symptoms suggestive of postinjection endophthalmitis or retinal detachment require prompt evaluation. (, , )
Recommendation Grading
Overview
Title
Age-Related Macular Degeneration
Authoring Organization
American Academy of Ophthalmology
Publication Month/Year
January 1, 2020
Last Updated Month/Year
April 1, 2024
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
Identify patients at risk of visual loss related to AMD. Educate patients and their families about the disease, risk factors, and preventive measures. Minimize or reverse visual loss and functional impairment in these patients through appropriate detection, self-assessment, treatment, and follow-up examinations. Help patients identify expert physicians and resources needed to facilitate improvement in vision
Target Patient Population
Patients 50 years of age and older with or without visual problems
Inclusion Criteria
Adult, Older adult
Health Care Settings
Ambulatory, Emergency care, Hospital, Outpatient
Intended Users
Optometrist, optician, nurse, nurse practitioner, physician, physician assistant
Scope
Diagnosis, Management
Diseases/Conditions (MeSH)
D008268 - Macular Degeneration, D000071700 - Cone-Rod Dystrophies, D005128 - Eye Diseases, D015785 - Eye Diseases, Hereditary
Keywords
macular degeneration, Neovascularization, hereditary macular dystrophies
Source Citation
Flaxel, C. J., Adelman, R. A., Bailey, S. T., Representative, R. S., Fawzi, A., Representative, M. S., … Ying, G. (2019). Age-Related Macular Degeneration Preferred Practice Pattern®. Ophthalmology. doi:10.1016/j.ophtha.2019.09.024