Age-related macular

degeneration: an update
Mr Samer Elsherbiny
Consultant Ophthalmologist
January 2017
 Introduction
• Age-related macular degeneration (ARMD)
– The disease and its management
– Future trends

• Service provision
– Current service
– Future possibilities
Age-related macular degeneration
Age-related macular degeneration
Age-related macular degeneration
Age-related macular degeneration
• Ageing change
– Dry
– Wet
Age-related macular degeneration
• Epidemiology
– Leading cause of irreversible visual loss Western
World (age 55+)
– Dry and wet forms: 2 thirds of UK CVI
– 450 new wet ARMD per million per year
– Prevalence:
• 4.8% for >65
• 12.2% for >80
• Predicted to increase by 33% between 2010 and 2020
Age-related macular degeneration
• Diagnosis
– History
– Clinical findings
– Differential diagnosis
– Diagnostic imaging
Age-related macular degeneration
• Diagnostic imaging
– Visual Acuity
– Ophthalmoscopy
– Angiography
– Ocular Coherence Tomography
– Others where needed (Electrophysiology)
– New technologies
Age-related macular degeneration
Amsler Grid (recording chart)
Age-related macular degeneration
• Management
– Prevention

– Treatment
Age-related macular degeneration
• Management
– Treatment
• Early referral (days)
• Intravitreal injections for those eligible (how many??)
• Long-term follow up (how long??)
• Counselling/support/CVI/other pathology
Age-related macular degeneration
• Ranibizumab (Lucentis)

• Aflibercept (Eylea)

• Photodynamic therapy
with verteporfin
(visudyne) (subtypes)

• Bevacizumab (avastin)
(subtypes)
Age-related macular degeneration
• Management
– Prevention

– Treatment
• Surgery
• Radiotherapy
Age-related macular degeneration
• Management
– Prevention
• Systemic
• Lifestyle/ Environmental
• Other
Age-related macular degeneration
• Management
– Prevention
• Systemic
– Hypertension
– Coronary and Vascular disease
– Statins
– Diabetes
– Genetics
Age-related macular degeneration
• Management
– Prevention
• Lifestyle/ Environmental
– Smoking
– Alcohol
– Diet/ Nutrition
• Anti-oxidants; lutein; zeaxanthine
• Polyunsaturated fats
– Obesity
– Exercise
Age-related macular degeneration
• Management
– Prevention
• Other
– Cataract Surgery
– Sunlight exposure
– Gender (sex hormones)
– Race/ethnicity
– Educational status/social class
Age-related macular degeneration
• Future trends
– New drugs
• Beware dry macular degenration
– New drug delivery devices
– New diagnostics (better structural and functional
analysis)
– Rehabilitation of existing patients
– New ways of working??
Age-related macular degeneration
Age-related macular degeneration
Age-related macular degeneration
Age-related macular degeneration
Age-related macular degeneration
• New ways of working??? Challenges:
– New to follow up ratios? (can you guess???)
– Patient pathway
– IT infrastructure
– Who is responsible for what
– Who is paid what
– Information governance
Age-related macular degeneration
• Extended roles in secondary care
• “Virtual clinics”
• Optometrists
• GP with specialist interest
• “Catchment area”/ CCG solutions
• Vanguards
 Summary
• Age-related macular degeneration (ARMD)
– The disease and its management
– Future trends

• Service provision
– Current service
– Future possibilities
 References
• https://www.rcophth.ac.uk/wp-
content/uploads/2014/12/2013-SCI-318-
RCOphth-AMD-Guidelines-Sept-2013-FINAL-
2.pdf
• https://www.rcophth.ac.uk/wp-
content/uploads/2015/04/2010-SCI-048-
AMD-Electronic-Referral-Form-edited.pdf
 References
• https://www.rcophth.ac.uk/publications/nhs-
england-conference-7-june-2016-address-
demand-and-capacity-pressures-in-the-
hospital-eye-service/
• https://www.rcophth.ac.uk/2016/06/ccgs-
urged-to-tackle-backlogs-at-nhs-england-eye-
health-summit/
 References
• https://www.rcophth.ac.uk/wp-
content/uploads/2014/12/2013-SCI-318-
RCOphth-AMD-Guidelines-Sept-2013-FINAL-
2.pdf
• https://www.rcophth.ac.uk/2016/05/rcophths
-three-step-plan-to-reduce-risk-for-eye-
patients/