By the American Academy of Ophthalmology Preferred Practice Pattern Retina/Vitreous Committee: Christina J. Flaxel, MD,1 Ron A. Adelman, MD, MPH, MBA, FACS,2 G. Atma Vemulakonda, MD,3 Steven T. Bailey, MD,4 Amani Fawzi, MD,5 Jennifer I. Lim, MD,6 Gui-shuang Ying, MD, PhD7
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1Casey Eye Institute, Oregon Health & Science University, Portland, OR
2Yale University Eye Center, New Haven, CT
3Department of Ophthalmology, Palo Alto Medical Foundation, Palo Alto, CA
4Casey Eye Institute, Oregon Health & Science University, Portland, OR
5Feinberg School of Medicine, Northwestern University, Chicago, IL
6University of Illinois at Chicago, Chicago, IL
7Center for Preventative Ophthalmology and Biostatistics, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
Highlighted Findings and Recommendations for Care
Although an estimated 80% of age-related macular degeneration (AMD) patients have non-neovascular or atrophic AMD, the neovascular form is responsible for the majority of the severe central visual acuity (VA) loss associated with AMD.
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.