Excerpt

Age-related macular degeneration (AMD) is the most common form of macular degeneration 3 and is the term given to ageing changes in the eye without any other obvious cause. These 4 changes occur in the central area of the retina (macula). It is a painless eye condition that 5 generally leads to the gradual impairment of vision, but can sometimes cause a rapid 6 reduction in vision. AMD may be an incidental finding on a routine visit to the optometrist or 7 people may present with difficulty in performing daily activities such as driving, reading and 8 recognising faces.

This guideline provides advice on the management of people with AMD, including 6 pharmacological and non-pharmacological treatments. It also provides guidance on tools 7 available to diagnose and monitor AMD, and what information and support should be 8 provided for people with AMD.

Contents

• Context
• 1. Guideline Committee membership and ICG technical team
  • 1.1. Guideline Committee membership and ICG technical team
• 2. Strength of recommendations
  • Interventions that must (or must not) be used
  • Interventions that should (or should not) be used – a ‘strong’ recommendation
  • Interventions that could be used
• 3. Methods
  • 3.1. Evidence synthesis and meta-analyses
  • 3.2. Evidence of effectiveness of interventions
  • 3.3. Methods for combining direct and indirect evidence (network meta-analysis) for interventions
  • 3.4. Diagnostic accuracy evidence
  • 3.5. Association studies
  • 3.6. Non-comparative studies
  • 3.7. Qualitative evidence
  • 3.8. Mixed-quantitative and qualitative evidence
  • 3.9. Systematic review
  • 3.10. Measures of visual acuity used in this guideline
• 4. Summary of recommendations
  • 4.1. Recommendations summary
  • 4.2. Research recommendations summary
• 5. Classification
  • 5.1. Classification systems for AMD
• 6. Risk factors
  • 6.1. Risk factors for development or progression of AMD
  • 6.2. Strategies to slow the progression of AMD
• 7. Diagnosis
  • 7.1. Signs and symptoms of AMD
  • 7.2. Tools for triage, diagnosis and informed treatment
• 8. Referral and treatment pathways
  • 8.1. Organisational models for AMD diagnosis and management
• 9. Non-pharmacological management
  • 9.1. Psychological therapies
  • 9.2. The effectiveness of support strategies for people with visual impairment and AMD
• 10. Pharmacological management
  • 10.1. Antiangiogenic therapies and frequency of administration
  • 10.2. Treatment in people presenting with visual acuity better than 6/12 or people presenting with visual acuity worse than 6/96
  • 10.3. Adjunctive therapies
  • 10.4. Switching and stopping antiangiogenic treatment for late AMD (wet)
• 11. Monitoring
  • 11.1. Frequency of monitoring
  • 11.2. Self-monitoring strategies
  • 11.3. Monitoring strategies and tools for people with late AMD (wet active)
• 12. Information
  • 12.1. Barriers and facilitators to appointment attendance and uptake of treatment for people with AMD
  • 12.2. Informational needs of people with suspected or confirmed AMD and their family members/carers
• 13. Glossary
• Appendix A. Committee membership list – Age-Related Macular Degeneration Committee
• Appendix B. Guideline scope
• Appendix C. Review protocols
• Appendix D. Review search strategies
• Appendix E. Evidence tables
• Appendix F. Excluded studies
• Appendix G. Network meta-analysis
• Appendix H. GRADE tables and meta-analysis results
• Appendix I. References for included and cited studies
• Appendix J. Health economics
• Appendix K. Age-related macular degeneration classification
• Appendix L. Research recommendations
• Appendix M. Expert witness testimonial
• Appendix N. Review flowcharts

Final

Commissioned by the National Institute for Health and Care Excellence

Disclaimer: Healthcare professionals are expected to take NICE clinical guidelines fully into account when exercising their clinical judgement. However, the guidance does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and/or their guardian or carer.