Management
12
Findings and Recommendations for Care
Î Patients who have been instructed to use aspirin by a physician should
continue to use it as prescribed. (II++, G, S)
Î Antioxidant vitamin and mineral supplementation as per the original
AREDS and AREDS2 trials should be considered in patients with
intermediate or advanced AMD. (I++, G, D)
Î Intravitreal injection therapy using pan-vascular VEGF inhibiting
agents (e.g., aflibercept, bevacizumab, and ranibizumab) is the most
effective way to manage neovascular AMD, and it represents the first
line of treatment. (I++, G, S)
Î Symptoms suggestive of postinjection endophthalmitis or retinal
detachment require prompt evaluation. (III, G, S)
Treatment Modalities
Î There is no evidence to support the use of antioxidant vitamin and
mineral supplements for patients who have less than intermediate
AMD. (I++, G, D)
Î A lower zinc dose (25 mg) in the AREDS2 formulation could be
considered. (I++, G, D)
Î Anti-VEGF therapies have become first-line therapy for treatment and
stabilizing most cases of neovascular AMD. (I++, G, S)
Î Most juxtafoveal lesions that may have been previously treated with
laser photocoagulation surgery are currently managed with anti-VEGF
agents. (III, G, S)
Î Patients with juxtafoveal lesions may also be considered eligible for the
off-label use of PDT with verteporfin. (III, G, D)
Î The current trend is to use anti-VEGF agents in preference to laser
photocoagulation for extrafoveal lesions. (III, G, S)
Î Laser surgery for extrafoveal lesions remains a less-commonly used,
yet reasonable, therapy. (III, M, D)
Î Radiation therapy, acupuncture, electrical stimulation, macular
translocation surgery, and adjunctive use of intravitreal
corticosteroids with verteporfin PDT are not recommended. (III, M, S)
