• American Optometric Association. Care of the patient with age-related macular degeneration. 2nd ed. St. Louis (MO): American Optometric Association; 1997. 47 p. (Optometric clinical practice guideline; no. 6). [73 references]

This is the current release of the guideline.

According to the guideline developer, this guideline has been reviewed on a biannual basis and is considered to be current. This review process involves updated literature searches of electronic databases and expert panel review of new evidence that has emerged since the original publication date.

Age-related macular degeneration

Diagnosis
Evaluation
Management

Optometry

Health Plans
Optometrists

• To identify ocular, personal, and environmental risk characteristics for age-related macular degeneration (AMD)
• To accurately diagnose AMD
• To develop a decision making strategy for management of patients at risk for severe vision loss from AMD
• To provide information and resources for appropriate patient education in the area of vision rehabilitation
• To propose a philosophy and rationale for management and prevention of AMD

Adults with age-related macular degeneration

Diagnosis of age-related macular degeneration

1. Patient history
2. 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
3. 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

Management of age-related macular degeneration

1. Laser photocoagulation treatment
2. Amsler gird self-assessment
3. Patient education
4. UVR protection
5. Antioxidant supplementation
6. Low vision consultation and evaluation
7. Consultation and referral

Not stated

Hand-searches of Published Literature (Primary Sources)
Searches of Electronic Databases

The guideline developer performed literature searches using the National Library of Medicine's Medline database and the VisionNet database.

Not stated

Expert Consensus (Committee)

Not stated

Review

Not applicable

Not stated

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Internal Peer Review

The Reference Guide for Clinicians was reviewed by the American Optometric Association (AOA) Clinical Guidelines Coordinating Committee and approved by the AOA Board of Trustees.

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:

1. Patient history
2. 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
3. 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

An algorithm is provided for Optometric Management of the Patient with AMD.

The type of supporting evidence is not specifically stated for each recommendation.

Until the means to prevent or cure age-related macular degeneration (AMD) are in place, optometrists need to understand the etiopathogenesis of the disease in order to reduce patient's risk for severe vision loss by early identification and timely referral for laser photocoagulation. Optometrists should educate and inform patients about the natural history of the retinal abnormalities associated with AMD. In certain cases useful vision can be maintained if the patient is informed and educated to seek care promptly. Improved patient understanding of AMD will promote compliance and in some cases may help preserve useful vision.

Subgroups Most Likely to Benefit:

Patients within the following groups at risk should be screened for signs and symptoms of age-related macular degeneration:

• Persons over 60 years of age
• Persons with hypertension or cardiovascular disease
• Cigarette smokers
• Persons with a first-degree family (sibling or maternal) history of vision loss from AMD regardless of age
• Persons with aphakia or pre-1984 pseudophakia
• Persons whose history indicates significant cumulative light exposure

Not stated

Clinicians should not rely on this Clinical Guideline alone for patient care and management. Please refer to the references and other sources listed in the original guideline for a more detailed analysis and discussion of research and patient care information.

An implementation strategy was not provided.

Getting Better
Living with Illness
Staying Healthy

Effectiveness
Patient-centeredness

• American Optometric Association. Care of the patient with age-related macular degeneration. 2nd ed. St. Louis (MO): American Optometric Association; 1997. 47 p. (Optometric clinical practice guideline; no. 6). [73 references]

Not applicable: The guideline was not adapted from another source.

1994 (reviewed 2004)

American Optometric Association - Professional Association

Funding was provided by the Vision Service Plan (Rancho Cordova, California) and its subsidiary Altair Eyewear (Rancho Cordova, California)

American Optometric Association Consensus Panel on Care of the Patient with Age-Related Macular Degeneration

Members: Anthony A. Cavallerano, O.D. (Principal Author); John P. Cummings, O.D.; Paul B. Freeman, O.D.; Randall T. Jose, O.D.; Leonard J. Oshinskie, O.D.; John W. Potter, O.D.

AOA Clinical Guidelines Coordinating Committee Members: John F. Amos, O.D., M.S., (Chair); Kerry L. Beebe, O.D.; Jerry Cavallerano, O.D., Ph.D.; John Lahr, O.D.; Richard Wallingford, Jr., O.D.

Not stated

This is the current release of the guideline.

According to the guideline developer, this guideline has been reviewed on a biannual basis and is considered to be current. This review process involves updated literature searches of electronic databases and expert panel review of new evidence that has emerged since the original publication date.

None available

None available

This summary was completed by ECRI on December 2, 1999. The information was verified by the guideline developer as of January 27, 2000.