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AGE-RELATED MACULAR DEGENERATION
Treatment Guideline Chart

Age-related macular degeneration is a common, chronic, progressive, degenerative disease that causes central loss of vision due to abnormalities that occurs in the pigment, neural and vascular layers of the macula.
The macular disorder may have one or more of the following:
- Formation of drusen which are localized deposits of extracellular material usually concentrated in the macula
- Abnormalities in the retinal pigment epithelium (eg hypopigmentation or hyperpigmentation)
- Retinal pigment epithelium and choriocapillaris geographic atrophy                                                                                                                                                                                                            - Neovascular (exudative) maculopathy                                                                                                                                                                                                                                                      - Choroidal neovascularization (CNV), polypoidal choroidal vasculopathy (PCV), reticular pseudodrusen, or retinal angiomatous proliferation

Decreased central vision and distortion of seeing straight lines are the most common symptoms.

Age-related%20macular%20degeneration Management

Follow Up

  • Frequency of follow-up depends on the type of AMD and risk of progression
  • Follow-up at regular intervals is recommended for early detection of asymptomatic and treatable CNV lesions
  • History documentation and physical examination is recommended every visit
  • Recommended monitoring examinations during follow-up include: 
    • Monocular near vision (using Amsler grid) monitoring
    • Visual acuity assessment at distance with correction
    • Stereoscopic biomicroscopic examination of the fundus
  • Patients treated with intravitreal anti-VEGF agents or underwent PDT with Verteporfin or thermal laser photocoagulation surgery should undergo biomicroscopy of the fundus, OCT, OCTA, FFA and fundus photography at regular intervals for earlier detection of signs of active exudation or disease progression

Schedule of Follow-up

  • Non-neovascular early AMD or advanced AMD with bilateral subfoveal geographic atrophy or disciform scars under observation
    • Follow-up examination with fundus photography, FFA, OCT or OCTA if appropriate at 6-24 months if asymptomatic
    • Advise immediate follow-up if new symptoms suggestive of CNV occur 
  • Non-neovascular AMD/intermediate or advanced AMD in antioxidant vitamin and mineral supplements
    • At 6-18 months after treatment if asymptomatic
    • Advise immediate consultation if new symptoms suggestive of CNV occurs
  • Subfoveal neovascular AMD in Aflibercept, Bevacizumab, Brolucizumab or Ranibizumab therapy
    • Approximately 4 weeks after treatment
    • Subsequent follow-up is based on clinical findings
  • Subfoveal neovascular AMD in Pegaptanib sodium therapy
    • Every 6 weeks with retreatments as indicated
  • Subfoveal neovascular AMD after PDT with Verteporfin
    • Every 3 months until stable, with retreatments as indicated
  • Extrafoveal neovascular AMD after laser photocoagulation therapy
    • At 2-4 weeks after treatment with FFA and then 4-6 weeks thereafter based on clinical and angiographic findings
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