Age-Related Macular Degeneration Preferred Practice Pattern ®

Age-Related Macular Degeneration Preferred Practice Pattern^®

Highlighted Findings and Recommendations for Care

Although an estimated 80% of patients with age-related macular degeneration (AMD) have non-neovascular or atrophic AMD, the neovascular form is responsible for most of the severe vision loss associated with AMD.

Risk factors for the development of advanced AMD include smoking, increasing age, northern European ancestry, and genetic factors. Cigarette smoking has been identified as the primary modifiable risk factor in numerous studies on advanced AMD. It is strongly recommended to advise patients with AMD or those at risk for AMD to stop smoking. Routine genetic testing is not currently recommended.

In light of all of the available information on aspirin use and AMD, the current preferred practice for patients who have been instructed by their physician that long-term aspirin is appropriate and beneficial is to continue with aspirin therapy as prescribed.

There is no evidence-based treatment for early AMD.

According to the Age-Related Eye Disease Study (AREDS2), antioxidant vitamin and mineral supplementation should be considered in patients with intermediate AMD or geographic atrophy (GA) in one or both eyes and other advanced AMD in one eye. 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. A Mediterranean diet is associated with a reduced risk of developing AMD and of existing AMD becoming worse.

Early detection and prompt treatment of active neovascular AMD improves visual outcomes. Intravitreal injection therapy using anti-vascular endothelial growth factor (VEGF) agents, which may or may not target other factors such as placental growth factor or angiopoietin-2, is the most effective way to manage neovascular AMD and is the first-line treatment. Symptoms suggestive of post-injection endophthalmitis or retinal detachment require prompt evaluation.

The choice of biologic product (reference, biosimilar, or interchangeable) should be that of the treating ophthalmologist and the patient whenever possible.


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