1. Age-related macular degeneration: an update
Mr Samer Elsherbiny
Consultant Ophthalmologist
January 2017

2. Introduction Age-related macular degeneration (ARMD) Service provision
The disease and its management
Future trends
Service provision
Current service
Future possibilities

3. Age-related macular degeneration

4. Age-related macular degeneration

5. Age-related macular degeneration

6. Age-related macular degeneration
Ageing change
Dry
Wet

9. 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

10. Age-related macular degeneration
Diagnosis
History
Clinical findings
Differential diagnosis
Diagnostic imaging

11. Age-related macular degeneration
Diagnostic imaging
Visual Acuity
Ophthalmoscopy
Angiography
Ocular Coherence Tomography
Others where needed (Electrophysiology)
New technologies

12. Age-related macular degeneration

14. Amsler Grid (recording chart)

17. Age-related macular degeneration
Management
Prevention
Treatment

19. 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

20. Age-related macular degeneration
Ranibizumab (Lucentis)
Aflibercept (Eylea)
Photodynamic therapy with verteporfin (visudyne) (subtypes)
Bevacizumab (avastin) (subtypes)

21. Age-related macular degeneration
Management
Prevention
Treatment
Surgery
Radiotherapy

22. Age-related macular degeneration
Management
Prevention
Systemic
Lifestyle/ Environmental
Other

23. Age-related macular degeneration
Management
Prevention
Systemic
Hypertension
Coronary and Vascular disease
Statins
Diabetes
Genetics

24. Age-related macular degeneration
Management
Prevention
Lifestyle/ Environmental
Smoking
Alcohol
Diet/ Nutrition
Anti-oxidants; lutein; zeaxanthine
Polyunsaturated fats
Obesity
Exercise

25. Age-related macular degeneration
Management
Prevention
Other
Cataract Surgery
Sunlight exposure
Gender (sex hormones)
Race/ethnicity
Educational status/social class

26. 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??

27. Age-related macular degeneration

28. Age-related macular degeneration

29. Age-related macular degeneration

30. Age-related macular degeneration

31. 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

32. Age-related macular degeneration
Extended roles in secondary care
“Virtual clinics”
Optometrists
GP with specialist interest
“Catchment area”/ CCG solutions
Vanguards

33. Summary Age-related macular degeneration (ARMD) Service provision
The disease and its management
Future trends
Service provision
Current service
Future possibilities

34. References

35. References

36. References