Summarized by the National Guideline Clearinghouse (NGC):
Diagnosis of Age-Related Macular Degeneration
The evaluation of patients with retinal changes suggestive of age-related
macular degeneration (AMD) or patients with diagnosed AMD may include, but is
not limited to the following areas:
- Patient history
- Ocular examination
- Best corrected visual acuity, including near
monocular visual acuity
- Amsler grid testing
- Sensorimotor examination
- Refraction
- Biomicroscopy
- Tonometry
- Stereoscopic fundus examination with pupillary dilation
- Supplemental testing
- Macular function assessment (e.g., contrast
sensitivity, photostress test)
- Color vision
- Central 10-degree computerized automated
perimetry
- Fundus photography (including the use of a
red-free filter)
- Scanning laser ophthalmoscope
These components of patient care are described in greater detail in the
guideline document.
Management of Age-Related Macular Degeneration
The extent to which an optometrist can provide medical treatment for
age-related macular degeneration may vary, depending on the state's scope of
practice laws and regulations and the individual optometrist's certification.
Treatment of the patient with AMD may require consultation with or referral to
the patient's primary care physician, an ophthalmologist, or other health care
practitioner for those services outside the optometrist's scope of practice.
Management of the patient with nonexudative AMD varies considerably from that
of the patient diagnosed with exudative AMD, for whom immediate treatment is
critical. Treatment options for patients with nonexudative AMD and exudative AMD
are described in greater detail in the guideline document.
The frequency and composition of evaluation and management visits for
age-related macular degeneration is summarized in the following
table:
Frequency and Composition of Evaluation and Management Visits for Age-Related Macular Degeneration
|
| Type of Patient |
Frequency of Examination |
Amsler Grid |
Stereo Fundus Biomicroscopy |
Central 10 degree Automated Visual Field (AVF) |
Fundus Photography |
Management Plan |
|
| Patient with two or more risk factors for AMD, over age 55 |
Annual examination |
Yes |
Yes |
Yes; baseline, repeat every 2 years |
Yes; baseline, repeat every 2 years or as necessary |
Patient education; Recommend UVR protection, antioxidant
supplementation, home Amsler weekly |
| Patient with hard drusen and/or pigmentary degeneration |
6 to 12 months depending on extent of atrophy |
Yes |
Yes |
Yes; repeat every 2 years |
Yes; repeat every 2 years |
Patient education; Recommend UVR protection, antioxidant
supplementation, home Amsler twice each week |
| Patient with geographic atrophy, VA 20/20-20/70 |
6 to 12 months depending on extent of atrophy |
Every interim visit |
Every interim visit |
Every 1 to 2 years |
Yes; repeat every year |
Patient education; Recommend UVR protection, antioxidant
supplementation, home Amsler every other day; Monitor for CNV |
| Patient at high risk with soft confluent drusen and granular
pigmentary degeneration |
4 to 6 months |
Every interim visit |
Every interim visit |
Annually |
Annually |
Patient education; Recommend UVR protection, antioxidant
supplementation, home Amsler daily; Low vision consultation and evaluation |
| Patient with CNV within 2500 microns of center of FAZ every 2
to 3 months |
2 weeks after FA laser photocoagulation; at 6 weeks, then
after repeat FA |
Every interim visit |
Every interim visit |
Semiannually |
Semiannually |
Patient education; Recommend UVR protection, antioxidant
supplementation, home Amsler daily; immediate consultation for signs of recurrent CNV; Low
vision consultation and evaluation |
| Patient with disciform scar in both eyes |
6 to 12 months |
Not necessary |
Every interim visit |
Annually; consider central 30º AVF, depending on central
fixation |
Annually |
Review; Low vision consultation and evaluation |
|
