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Age-Related Macular Degeneration

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5 Î Intravenous fundus fluorescein angiography is helpful to detect persistent or recurrent CNV or other retinal diseases following treatment. (III, In, D) Î Intravenous fundus fluorescein angiography is helpful to assist in determining the cause of visual loss that is not explained by the clinical examination. (III, In, D) Î If CNV is suspected on the basis of new symptoms or ocular findings, fluorescein angiography should be performed and interpreted expeditiously by an individual experienced in managing patients with neovascular AMD. (III, G, S) Î If fluorescein angiography is performed, the physician must be aware of potential risks associated with this procedure. (II-, G, S) Î Each angiographic facility should have a care plan in place for an emergency situation, as well as a clear protocol to minimize the risks and to manage complications. (III, G, S) Î Color fundus photographs may be obtained when angiography is performed, because they are useful in finding landmarks, evaluating serous detachments of the neurosensory retina and RPE, and determining the etiology of blocked fluorescence. (III, G, D) Î Fundus photographs may also be used as a baseline reference for selected patients with advanced non-neovascular AMD and for follow- up of treated patients. (III, G, D) Î Indocyanine green (ICG) angiography has been shown to be useful in evaluating specific forms of AMD, such as pigment epithelial detachment, poorly defined CNV, occult CNV, and lesions including retinal angiomatous proliferation or idiopathic polypoidal choroidal vasculopathy. (II-, M, D) Î When ICG angiography is performed, the physician must be aware of potential risks associated with this procedure: severe medical complications, allergic reactions, and even death. (III, G, S) Î Several other tests including fundus autofluorescence, microperimetry and adaptive optics have been used for evaluation of patients with AMD. However, their role in clinical practice is poorly defined at this time. (III, In, D) Î Patients with early AMD and/or a family history of AMD should be encouraged to assess their own visual acuity using monocular vision testing (i.e., Amsler grid), and have scheduled dilated eye examinations for detecting the intermediate stage of AMD. (III, G, S)

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