Agerelated macular degeneration an update Mr Samer Elsherbiny
Age-related macular degeneration: an update Mr Samer Elsherbiny Consultant Ophthalmologist January 2017
Introduction • Age-related macular degeneration (ARMD) – 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) – The disease and its management – Future trends • Service provision – Current service – Future possibilities
References • https: //www. rcophth. ac. uk/wpcontent/uploads/2014/12/2013 -SCI-318 RCOphth-AMD-Guidelines-Sept-2013 -FINAL 2. pdf • https: //www. rcophth. ac. uk/wpcontent/uploads/2015/04/2010 -SCI-048 -AMDElectronic-Referral-Form-edited. pdf
References • https: //www. rcophth. ac. uk/publications/nhsengland-conference-7 -june-2016 -addressdemand-capacity-pressures-in-thehospital-eye-service/ • https: //www. rcophth. ac. uk/2016/06/ccgsurged-to-tackle-backlogs-at-nhs-england-eyehealth-summit/
References • https: //www. rcophth. ac. uk/wpcontent/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-eyepatients/
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