Active management of AMD can allow patients to enjoy additional years of good central vision, enhancing the odds of a better quality of life. Diagnosing the disease as early as possible offers time to take measures that may slow progression.
The primary goal of every optometrist is to preserve the vision of our patients. Detecting, monitoring, and treating AMD are imperative to our mission. We can detect earlier than ever before and manage AMD by doing all we can to prevent progression to advanced stages and complications such as CNV.
Industry Leaders Set Forth Treatment Recommendations
The authors of the Practical Guidelines for the Treatment of AMD state, “Based upon our current understanding of AMD pathogenesis, the stages of subclinical, early, and intermediate AMD all represent different clinical manifestations of the same underlying disease process. Thus, the treatment of the disease should be initiated at first detection, regardless of the stage.” ii
Taking Action to Preserve Vision
The Practical Guidelines set forth treatment recommendations for all stages of AMD.
Recommend Smoking Cessation Programs
Smoking is the largest modifiable risk factor for the progression of both choroidal neovascularization (CNV) and geographic atrophy (GA).ii Current smokers carry a 2.5 to 4.8 times higher risk than non-smokers for late AMD,ii yet in one study, 90% of patients with AMD were not advised to stop smoking.ii
Prescribe Nutritional Supplementation
Although there is extensive debate about which supplements are most appropriate, evidence strongly supports prescribing nutraceuticals. On average, patients that take supplements have better outcomes than those who do not.ii
Discuss Diet and Exercise
Following a healthy diet, exercising regularly, and maintaining overall health are sound goals for all patients.ii These lifestyle choices may act synergistically to prevent or delay onset or progression of AMD. One study found that women who followed a healthy diet, engaged in physical exercise, and avoided smoking had substantially lower risk of early AMD compared with women who did not follow these healthy choices.ii
Explain the Importance of Managing Other Chronic Diseases
Based on epidemiological studies, several systemic conditions increase the risk of developing AMD. Cardiovascular disease, diabetes, high cholesterol, and obesity have all been associated with increased risk of AMD and/or progression of AMD.ii Body mass index and abdominal obesity are independent risk factors for progression to advanced AMD.ii Primary eye care professionals can partner with primary care providers to co-manage patients’ health.
Prescribe Retinal Light Protection
Epidemiological evidence suggests that chronic sunlight exposure increases the risk of incident AMD and its progression.ii Based on increased study in this area, eye care professionals should consider recommending HEVL-blocking eyeglass lenses.
Monitor Disease Progression
For a patient with AMD, more frequent retinal examinations are recommended. Moving from a 12-month follow-up interval to a 6-month (or even shorter in some cases) follow-up interval may be useful for monitoring disease progression.ii More frequent visits provide the clinician increased opportunity to detect CNV before irreversible vision loss occurs.
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Practical Opportunities in AMD Management
Enlightening, expert knowledge revealing opportunities in AMD management including proactive disease response, understanding supplement research, and implementing dark adaptation testing.
I have been in eye care since the late 90s and I remember that macular degeneration was just a condition that was very difficult to detect and even once detected, it was difficult to do anything about it. So, essentially, we were just watching patients go blind. Now that we have the AdaptDx, it’s made a world of a difference in diagnosing patients.