EARLY DETECTION AND MANAGEMENT OF CHOROIDAL NEOVASCULARISATION IN AGE-RELATED MACULAR DEGENERATION THE ROLE OF PRIMARY CARE PHYSICIAN AND OPHTHALMOLOGIST
Abstract
Background. Choroidal neovascularisation (CNV) secondary to age-related macular degeneration (ARMD) is a serious condition which, if unrecognised and untreated, can result in the rapid deterioration of vision. Early detection and prompt referral to ophthalmologist and then to retinal specialist may reduce the high risk of severe vision loss.
Conclusions. Patients over 65 years who present to a primary care physician with a sudden blurred central vision or distorted near vision should be referred to an ophthalmologist as soon as posible. ARMD patients with clinical picture of CNV would be send forward to urgent fluorescein angiography, to provide the information about location, size and composition of CNV, and to present treatment possibilities.
Laser photocoagulation or photodynamic therapy (PDT) with verteporfin may prevent further severe visual loss.
Downloads
References
Haab O. Erkrankungen der Macula Lutea. Centralblat Augenheilkd 1885; 9: 384–91.
Hyman L, Schachat AP, He Q, Leske MC for Age-Ralated Macular Degeneration Study Group. Hypertension, cardio-vascular disease, and age-related macular degeneration. Arch Ophthalmol 2000; 118: 351–8.
Gass JDM. Pathogenesis of disciform detachment of the neuroepithelium (part I and III). Am J Ophthalmol 1967; 63: 573–711.
Bird AC, Bressler NB, Bressler SB, Chisholm IH et al. The International ARM Epidemiological Study Group: An International classification and grading system for age-related maculopathy and age-related macular degeneration. Surv Ophthalmol 1995; 39: 367–74.
Bressler NM, Bressler SB, Fine SL. Neovascular (exudative) age-related macular degeneration. In: Ryan SJ. Retina. 3rd ed. Vol 2. St. Louis: Mosby, 2001: 1100–35.
Klein R, Klein BEK, Jensen SC, Meuer SM. The five-year incidence and progression of age-related maculopathy. The Beaver Dam eye study. Ophthalmology 1997; 104: 7–21.
Vingerling JR, Dielemans I, Hofman A, Grobbee DE et al. The prevalence of age-related maculopathy in the Rotterdam study. Ophthalmology 1995; 102: 205–10.
Mitchell P, Smith W, Attebo K, Wang JJ. Prevalence of age-related maculopathy in Australia. The Blue Mountains eye study. Ophthalmology 1995; 102: 1450–60.
Foran S, Wang JJ, Mitchell P. Causes of visual imparment in two older population cross-sections: the Blue Mountains eye study. Ophthalmic Epidemiol 2003, 10: 215–25.
Thylefors B, Negrel AD, Pararajasegaram R, Dadzie KY. Global data on blindness. Bull World Health Organ 1995; 73: 115–21.
Farber MD. National registry for the blind in Israel: estimation of prevalence and incidence rates and causes of blindness. Ophthalmic Epidemiol 2003; 10: 267–77.
Ferris FL, III, Fine SL, Hyman L. Age-related macular degeneration and blindness due to neovascular maculopathy. Arch Ophthalmol 1984; 102: 1640–2.
Macular Photocoagulation Study Group. Risk factors for choriodal neovascularisation in the second eye of patients with juxtafoveal or subfoveal choroidal neovascularisation secondary to age-related macular degeneration. Arch Ophthalmol 1997; 115: 741–7.
Williams RA, Brody BL, Thomas RG, Kaplan RM, Brown SI. The psychosocial impact of macular degeneration. Arch Ophthalmol 1998; 116: 514–20.
Haddad WM, Coscas G, Soubrane G. Eligibility for treatment and angiographic features at the early stage of exudative age-ralated macular degeneration. Br J Ophthalmol 2002; 86: 663–9.
Sickenberg M. Early detection, diagnosis and management of choroidal neovascularisation in age-related macular degeneration: the role of ophthalmologists. Ophthalmologica 2001; 215: 247–53.
American Academy of Ophthalmology. Frequency of ocular examinations. Policy Statement N° 808. American Academy of Ophthalmology, 1990.
Age-Related Eye Disease Study Research Group. A randomized, placebo controlled, clinical trial of high-dose supplementation with vitamin C and E and beta carotene for age-related cataract and vision loss. AREDS report N°9. Arch Ophthalmol 2001; 119: 1439–52.
Macular Photocoagulation Study Group. Laser photocoagulation of subfoveal neovascular lesion in age-related macular degeneration. Arch Ophthalmol 1991; 109: 1220–31.
Ciulla TA, Danis RP, Harris A. Age-related macular degeneration; a review of experimental treatments. Surv Ophthalmol 1998; 43: 134–46.
Henderson BW, Dougherty TJ. How does photodynamic therapy work? Photochem Photobiol 1992; 55: 145–57.
Verteporfin roundtable 2000 and 2001 participants. Guedlines for using verteporfin (Visudyne) in photodynamic therapy to treat choroidal neovascularization due to age-related macular degeneration and other causes. Retina 2002; 22: 6–18.
Treatment of Age-Relaed Macular Degeneration with Photodynamic Therapy Study Group. Photodynamic therapy of subfoveolar choroidal neovascularization in age-related macular degeneration with verteporfin. Oneyear results of 2 randomized clinical trials – TAP report 1. Arch Ophthalmol 1999; 117: 1329–45.
Treatment of Age-Relaed Macular Degeneration with Photodynamic Therapy Study Group. Photodynamic therapy of subfoveolar choroidal neovascularization in age-related macular degeneration with verteporfin. Twoyear results of 2 randomized clinical trials – TAP report 2. Arch Ophthalmol 2001; 119: 198–207.
Verteporfin in Photodynamic Therapy (VIP) Study Group. Verteporfin therapy of subfoveolar choroidal neovascularization in age-related macular degeneration: two-year results of a randomized clinical trial including lesions with occult with no classic choroidal neovascularization – Verteporfinin photodynamic therapy report 2. Am J Ophthalmol 2001; 131: 541–60.
Verteporfin in Photodynamic Therapy (VIP) Study Group. Photodynamic therapy of subfoveolar choroidal neovascularization in patholocic myopia with verteporfin: 1-year results of a randomized clinical trial – VIP report No. 1. Ophthalmology 2001; 108: 841–52.
Spaide RF, Martin ML, Slakter J, Yannuzzi LA et al. Treatment of idiopathic subfoveal choroidal neovascular lesions using photodynamic therapy with verteporfin. Am J Ophthalmol 2002; 98: 62–8.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
