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Age-Related Macular Degeneration

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Issue link: https://eguideline.guidelinecentral.com/i/557417

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1 Î Although an estimated 80% of age-related macular degeneration (AMD) patients have non-neovascular or atrophic AMD, the neovascular form is responsible for nearly 90% of the severe central visual acuity loss associated with AMD. Î The primary risk factors for the development of advanced AMD include increasing age, ethnicity, and genetic factors. Cigarette smoking is the main modifiable risk factor that has been consistently identified in numerous studies. Smoking cessation is strongly recommended when advising patients who have AMD or are at risk for AMD. Î A meta-analysis of 10 studies found that the use of aspirin may not be associated with an increased risk of AMD. Therefore, patients who have been instructed by a physician to use aspirin should continue to use it as prescribed. Î Antioxidant vitamin and mineral supplementation as per the original Age-Related Eye Disease Study (AREDS) and AREDS2 trials should be considered in patients with intermediate or advanced AMD. There is no evidence to support the use of these supplements for patients who have less than intermediate AMD. Î Replacement of the beta-carotene from the original AREDS formulation with lutein/zeaxanthin in the AREDS2 supplements may decrease the risk of lung cancer in smokers. Î In patients with neovascular AMD, early detection and prompt treatment improves the visual outcome. Treatment with AREDS2 supplements reduces the progression to advanced AMD in the fellow eye. Î Fundus angiography and optical coherence tomography (OCT) are useful diagnostic tests in clinical practice to detect new or recurrent neovascular disease activity and guide therapy. Î Intravitreal injection therapy using anti-vascular endothelial growth factor (VEGF) agents (e.g., aflibercept, bevacizumab, and ranibizumab) is the most effective way to manage neovascular AMD and represents the first line of treatment. Î Intravitreal anti-VEGF therapy is generally well tolerated and rarely associated with serious adverse events such as infectious endophthalmitis or retinal detachment. Symptoms suggestive of postinjection endophthalmitis or retinal detachment require prompt evaluation.

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