Age-related macular degeneration: an update Mr Samer Elsherbiny Consultant Ophthalmologist January 2017
Introduction Age-related macular degeneration (ARMD) Service provision 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) Service provision 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/