Early Detection and Treatment of Neovascular Age-related Macular Degeneration

Neil M. Bressler, MD

Disclosures

J Am Board Fam Med. 2002;15(2) 

In This Article

Abstract and Introduction

Abstract

Background: The neovascular form of age-related macular degeneration (AMD) can rapidly lead to severe loss of central vision and adversely affect the patient's quality of life. During the 1990s the only proven treatment for neovascular AMD was laser photocoagulation. Only a minority of patients are eligible to receive this treatment, however, and the treatment itself can cause acute retinal damage with immediate vision loss. Verteporfin therapy is a new treatment option involving photodynamic therapy that was recently shown to be relatively safe and effective in reducing the risk of vision loss in selected cases.
Methods: Recent literature was reviewed on management of choroidal neovascularization caused by AMD that proved beneficial in large-scale randomized clinical trials. These studies were selected through a MEDLINE search of files from 1982 to the present using the keywords "randomized clinical trials," "choroidal neovascularization," and "age-related macular degeneration," as well as through personal knowledge of recently completed trials.
Results and Conclusions: Primary care physicians can effect good treatment outcomes by detecting early signs of AMD and educating patients about the necessity of prompt referral to an ophthalmologist. Immediate referral is increasingly important because, compared with laser photocoagulation, current photodynamic therapy with verteporfin is applicable to more patients. Greater patient awareness of neovascular AMD and the importance of self-testing of vision can also be communicated to patients in primary care.

Introduction

Primary care physicians can play an important role in preventing loss of vision in patients with age-related macular degeneration (AMD). This condition is the most frequent cause of severe vision loss in persons older than 50 years in the Western world.[1] The prevalence of AMD increases with age and is likely to rise as the population of those older than 65 years increases. Worldwide estimates indicate that by 2020 as many as 8 million persons older than 65 years could suffer from AMD.[2]

To assist in the management of this common condition, primary care physicians should understand the natural history of AMD, know how to recognize those persons at risk of developing severe vision loss, and be able to interpret the earliest symptoms of the disease. They can also educate patients about AMD and refer appropriate patients promptly so that suitable treatment can be started, if indicated.[3] An international survey found that only 2% of adults considered AMD to be the leading cause of blindness among those older than 50 years, and 82% of those surveyed were not familiar with AMD.[4] To enhance the benefits that can be achieved with therapy for AMD, it is important to increase awareness among primary care physicians and their patients.

A new treatment for neovascular AMD, verteporfin combined with photodynamic therapy, has proved beneficial and has been approved by regulatory authorities in many countries, including the European Union and the United States. Previously, the only available treatment was laser photocoagulation. Because of this new treatment, the number of patients with AMD who can be treated has increased considerably.

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