4
Diagnosis
Care Process
Î The initial evaluation of a patient with signs and symptoms suggestive
of AMD includes all features of the comprehensive adult medical eye
evaluation, with particular attention to those aspects relevant to AMD.
(II++, G, S)
Î An initial history should consider symptoms of metamorphosia,
decreased vision, scotoma, photopsia. (II-, G, S)
Î An initial history should consider medication and nutritional
supplement use. (III, G, S)
Î An initial history should consider ocular history, medical history, and
family history. (II+, G, S)
Î An initial history should consider social history. (III, G, S)
Î A physical examination should include a comprehensive eye exam.
(II++, G, S)
Î A physical examination should include stereoscopic biomicroscopic
examination of the macula. (III, G, S)
ÎBinocular slit-lamp biomicroscopy of the ocular fundus is often
necessary to detect subtle clinical signs of CNV. (III, G, S)
Î Optical coherence tomography (OCT) is important in diagnosing and
managing AMD, particularly with respect to determining the presence
of subretinal fluid and in documenting the degree of retinal thickening.
(III, G, S)
Î OCT also assists in evaluating the response of the retina and RPE to
therapy by allowing structural changes to be followed accurately.
(II+, G, S)
Î Newer-generation OCT modalities, including spectral domain OCT
(SD-OCT), are preferred technologies. (III, In, D)
Î Intravenous fundus fluorescein angiography is indicated when the
patient complains of new metamorphopsia or has unexplained blurred
vision, and/or when clinical examination reveals elevation of the
RPE or retina, macular edema, subretinal blood, hard exudates, or
subretinal fibrosis. (II-, G, S)
Î Intravenous fundus fluorescein angiography is helpful to detect the
presence of and determine the extent, type, size, and location of CNV.
(III, In, D)
Î If verteporfin photodynamic therapy (PDT) or laser photocoagulation
is being considered, the angiogram is also used as a guide to direct
treatment. (III, In, D)
