Age-related macular degeneration | Guidance and guidelines | NICE
Find out how the right treatment for age-related macular degeneration Talk to your doctor about the best way to manage your condition. With the severe form of either wet or dry AMD, your central vision may decrease to. NB Eyes may still develop or have a recurrence of late AMD (wet active) with them, see the NICE guideline on patient experience in adult NHS services. Assess the person's priorities when making management decisions. Overall, more than 90% of my wet AMD patients need ongoing dosing, in many .. wet AMD? How do you use personalized disease management to reach dis-.
A large benefit in vision of patients treated with ranibizumab was initially highlighted in large multicenter trials, followed by the use of bevacizumab and recently aflibercept [ 5 — 9 ]. Moreover, diagnostic technologies, and especially optical coherence tomography OCT have revolutionized the AMD diagnosis and treatment algorithm [ 10 ]. However, despite positive developments in disease management, there are no commonly accepted therapeutic response evaluation criteria.
This is particularly true when the discussion is not limited to patients that are selected based on criteria similar to those in large clinical trials, but when referring to the individual patient, treated by an ophthalmologist in everyday clinical practice. In addition, there is ongoing research for parameters predictive or suggestive of no response to anti-VEGF therapy since the characteristics of patients not responding to treatment are not clearly defined. Thus, deriving the maximum possible benefit for each individual patient in the clinic becomes more difficult.
The purpose of this article is to present guidelines, compiled by a panel of specialized ophthalmologists in the area of wAMD, and propose commonly accepted therapeutic response criteria and define treatment discontinuation criteria for patients suffering from wAMD treated with anti-VEGF agents.
Methods A team of Greek retina experts developed a consensus paper after three consecutive meetings. Sources of data A systematic computerized literature search was conducted on PubMed http: Currently, practitioners are spoilt for choice of these agents. Areas of controversy Bevacizumab is unlicensed for intraocular use but has a better market share than ranibizumab in the treatment of wet AMD as it is approximately 40 times cheaper than ranibizumab, if aliquoted into smaller doses for intraocular use.
This has stirred up questions on indemnity, safety, dosing, treatment regimen and quality control, despite the fact that well-designed clinical trials have shown that both drugs are equally effective.
Another dilemma for the physicians is the choice of treatment regimens with antiVEGF agents that include fixed dosing, optical coherence tomography OCT -guided re-treatment, treat and extend or a combination of proactive and reactive dosing. Real-life outcomes of physician-dependent OCT-guided re-treatment with these agents are inferior to outcomes reported in clinical trials. Growing points A recently food and drug administration-approved antiVEGF agent, aflibercept, is rapidly becoming a popular choice as well-designed randomized clinical trials indicate that eight weekly fixed dosing of aflibercept is non-inferior to monthly ranibizumab.
Areas timely for developing research Options for reducing the frequency of repeated intravitreal injections are being explored. Combination therapy with photodynamic therapy and epimacular brachytherapy seem scientifically plausible due to their synergistic effects. However, so far the results on these combinations have not shown any superior visual outcomes to antiVEGF monotherapy, and the practicalities of delivering these therapies are formidable.
- METHODS AND KEY TO RATINGS
Age-related macular degeneration doesn't affect your side peripheral vision and usually doesn't cause total blindness. But it can reduce or eliminate your central vision — which is necessary for driving, reading and recognizing people's faces.
It may be beneficial for you to work with a low vision rehabilitation specialist, an occupational therapist, your eye doctor and others trained in low vision rehabilitation. They can help you find ways to adapt to your changing vision.
Request an Appointment at Mayo Clinic Clinical trials Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease. Lifestyle and home remedies Even after receiving a diagnosis of wet macular degeneration, you can take steps that may help slow vision loss. If you smoke, ask your doctor for help to quit. Choose a healthy diet. The antioxidant vitamins in fruits and vegetables contribute to eye health. Kale, spinach, broccoli, squash and other vegetables have high levels of antioxidants, including lutein and zeaxanthin, which may benefit people with macular degeneration.
Foods containing high levels of zinc also may be of particular value in patients with macular degeneration. These include high-protein foods, such as beef, pork and lamb. Nonmeat sources include milk, cheese, yogurt, whole-grain cereals and whole-wheat bread. Another good choice is healthy unsaturated fats, such as olive oil.
Age-related macular degeneration
And research studies have shown that a diet high in omega-3 fatty acids, such as those found in salmon, tuna and walnuts, may lower the risk of advanced macular degeneration. But the same benefit is not shown from taking omega-3 supplements, such as fish oil pills.
Manage your other medical conditions. If you have cardiovascular disease or high blood pressure, for example, take your medication and follow your doctor's instructions for controlling the condition.
Maintain a healthy weight and exercise regularly. If you need to lose weight, reduce the number of calories you eat and increase the amount of exercise you get each day. Have routine eye exams. Ask your eye doctor about the recommended schedule for follow-up exams.Hemal Mehta, EURETINA 2018 – Wet Age-related Macular Degeneration and the PanOptica Eye Drop
In between checkups, you can do a self-assessment of your vision using an Amsler grid. Vitamin supplements For people with intermediate or advanced disease, taking a high-dose formulation of antioxidant vitamins and minerals may help reduce the risk of vision loss, the American Academy of Ophthalmology says. Research shows benefit in a formulation that includes: Ask your doctor if taking supplements is right for you.
Age-Related Macular Degeneration PPP - Updated - American Academy of Ophthalmology
Coping and support Vision loss from macular degeneration can affect your ability to do things such as read, recognize faces and drive. These tips may help you cope with your changing vision: Ask your eye doctor to check your eyeglass prescription. If you wear contacts or glasses, be sure your prescription is up to date. If new glasses don't help, ask for a referral to a low vision specialist.
A variety of magnifying devices can help you with reading and other close-up work, such as sewing. Such devices include hand-held magnifying lenses or magnifying lenses you wear like glasses. You may also use a closed-circuit television system that uses a video camera to magnify reading material and project it on a video screen.
Change your computer display and add audio systems. Adjust the font size in your computer's settings. And adjust your monitor to show more contrast. You may also add speech-output systems or other technologies to your computer. Use electronic reading aids and voice interface. Try large-print books, tablet computers and audio books. Some tablet and smartphone apps are designed to help people with low vision.
And many of these devices now come with a voice recognition feature.