Opportunity to improve care for people with suspected late stage macular degeneration, says NICE

People with suspected late age-related macular degeneration (AMD) should be referred to a macula service within one working day, says NICE in guidance published today.

This new guideline makes recommendations about diagnosing, monitoring and treatment as well as the information and support that should be offered to patients.

AMD is the term given to ageing changes that occur in the central area of the retina (macula) that affect a person’s ability to perform daily activities such as driving, reading and recognising faces.

According to the Macular Society, over 600,000 people in the UK are affected by AMD which is increasing as the population ages.

AMD is classified as early, intermediate or late according to the stage of disease progression. It is then further classified into two forms; dry and wet. Dry AMD progresses slowly and requires monitoring, whereas the wet form can lead to a rapid worsening of vision.

The guideline recommends that people with suspected late AMD (wet active) are referred to a macula service quickly so that they can be given a prompt diagnosis and fast access to effective treatments.

For eyes with confirmed late AMD (wet active), anti-vascular endothelial growth factor (anti-VEGF) drugs should be offered within 14 days of referral to the macula service.

Anti-VEGF treatment is recommended in accordance with existing NICE technology appraisal (TA) guidance for treating late AMD (wet active). These drugs are injected into the eye and prevent the abnormal growth of blood vessels which cause the deterioration in sight¹.

Professor Mark Baker, Director of the Centre for Guidelines at NICE, said: €œAMD can be a life changing condition for people if it is not identified early on. There are around 26,000 new cases of wet AMD in the UK each year and if left untreated over half will become visually impaired or blind within 3 years. Therefore the need to provide timely diagnosis and treatment is important.€

In all cases the recommendations are for people with visual acuity between 6/12 and 6/96. In eyes with visual acuity worse than this, the guidance recommends that treatment should also be considered if it’s expected to improve the person’s overall visual function (for example, if the affected eye is the person’s better-seeing eye).

It also states that anti-VEGF treatment in eyes with a visual acuity better than 6/12 is clinically effective and may be cost effective depending on the regimen used.

The guideline also includes recommendations on non-drug strategies to manage AMD, such as group based rehabilitation programmes.

Waqaar Shah, GP at Chatfield Health Care and chair of the guideline committee, said: €œPeople with AMD can feel isolated and are at increased risk of depression. It is important they are given the right support at the right time to help them with this condition. This new guideline will help ensure therapeutic, social and psychological support is available to help patients in their daily lives.€

NHS organisations should compare their current practice with these recommendations and consider what changes may need to be made to put them into practice. In considering any changes, they will need to take into account any extra costs and savings involved. The speed at which these recommendations are adopted by local NHS services will depend on the resources they have available and the other priorities they are dealing with.