Age–Related Macular Degeneration: Diagnosis and Treatment

Diagnosis

ARMD is diagnosed by the characteristic appearance of the macula, as examined after dilation, and with direct ophthalmoscope or with a fundus lens at the slit lamp.

Slit–lamp photography of the macula is sometimes performed to document progression.

Fluorescein angiography detects the presence and location of any subretinal neovascularization.

Treatment

Vitamins C, E, beta–carotene and zinc are potentially valuable therapies (see Nutritional Considerations).

Dry ARMD

No specific medical or surgical treatment for the dry form of ARMD exists. Laser therapy needs further study.

Gingko biloba improved visual acuity in a small study (with unmasked assessment of outcome),⁶ and a larger more recent study.⁷ Further investigation is warranted.

Wet ARMD

If fluorescein angiography reveals classic neovascularization, thermal laser photocoagulation or photodynamic (laser) therapy may be used. However, recurrences are common.

Photodynamic therapy (PDT), which is performed after intravenous injection of verteporfin that differentially enters neovascular tissue, offers limited benefit to patients with several forms of wet ARMD.⁸

For neovascular ARMD, a VEGF inhibitor, pegaptanib, has shown modest benefit. In addition, ranibizumab (a VEGF inhibitor that awaits FDA approval) and off–label bevacizumab injections show promise for treatment of neovascular ARMD.

Submacular surgery is generally not recommended, except possibly when large hemorrhages are present.

Macular translocation surgery has many complications, but could be a viable alternative for those who are not candidates for laser therapy. However, it remains unclear which patients, if any, are best served by this invasive approach.