Dry AMD
Patients with a new diagnosis of AMD may wish to be referred to support groups for AMD if these are available locally. They may provide valuable support and advice. If the patients vision is poor enough for blind registration, the hospital may have decided to register the patient so that they can get increased support from social services.
Patients are generally advised to try to eat a diet rich in green leafy vegetables and to stop smoking if they do smoke; both of these actions may slow the rate of progression of AMD. Certain vitamin supplements that can be obtained from health food shops and some optometrists may be useful7. For more information see the Prevention section.
Because dry AMD can change to wet AMD (for which there are now treatments available), it is wise to advise the patient to report any sudden deterioration in their vision.
The main symptoms that might suggest a change are a sudden reduction in visual acuity associated with marked distortion of their vision. Examining one eye at a time with an Amsler chart (ask them to look focus on the spot at the centre of the chart and see if the surrounding lines look straight or wavy) or by just checking if things that they know are straight, eg the window frames, edges of a table, are straight or if they have become kinked, can be helpful.
Examination would then need to be performed to look for signs of wet AMD (haemorrhage and swelling of the macula) and an urgent referral to ophthalmology made.
Wet AMD
They would then be considered for treatment which currently takes the form of injections of an antiVEGF drug called ranibizumab into the vitreous at the back of the eye approximately every 4 weeks (protocols vary; most depend on patient response to an initial course of three injections). They usually remain under follow-up in the eye hospital.
There is no treatment given in between injections, apart from 3-4 days of topical antibiotics following each injection. If, however, a patient develops new symptoms or deterioration in their symptoms between their injections, they should be urgently referred to ophthalmology for review. Injections into the eye can lead to infection inside the eye (endophthalmitis), which can be sight threatening, or retinal tears or detachments, which would require further surgical intervention; these need urgent review.
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