6
Management
Î Patients who are currently smoking should be advised to stop.
(I++, G, S)
Î Treatment with antioxidants and minerals as described previously
in the original Age-Related Eye Disease Study (AREDS) and
AREDS2 trials is recommended for patients who have progressed to
intermediate or advanced age-related macular degeneration (AMD) in
at least one eye. (I++, G, S)
Î Patients with a high risk AMD phenotype are at increased risk of
progression to advanced AMD and should be educated about methods
of detecting new symptoms of choroidal neovascularization (CNV)
including self-monitoring. (III, G, S)
Î Patients with a high risk AMD phenotype should be educated about the
need for promptly reporting new symptoms to an ophthalmologist who
can confirm if the new symptoms are from CNV and who can begin any
necessary treatment. (III, G, S)
Î Electronic monitoring devices are now available to aid in the detection
of neovascularization at an early stage. (I+, G, D)
Î A history and examination are the recommended elements of the
follow-up visits. (III, G, S)
Î The follow-up history should take into account symptoms, including
decreased vision and metamorphopsia. (II-, G, S)
Î The follow-up history should take into account changes in medications
and nutritional supplements. (III, G, S)
Î The follow-up history should take into account changes in medical and
ocular history. (II+, G, S)
Î The follow-up history should take into account changes in social
history (smoking). (III, G, S)
Î The examination on the follow-up visit should include visual acuity.
(III, G, S)
Î The examination on the follow-up visit should include stereoscopic
biomicroscopic examination of the fundus. (III, G, S)
Î Patients who have been treated with aflibercept, bevacizumab,
ranibizumab, or pegaptanib sodium injection; verteporfin
photodynamic therapy (PDT); or thermal laser photocoagulation
surgery should be examined at regular intervals by means of
biomicroscopy of the fundus. (III, G, S)
Î Optical coherence tomography (OCT), fluorescein angiography, and
fundus photography may be helpful to detect signs of active exudation
or disease progression and should be used when clinically indicated.
(III, In, D)
