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If a genetic test (described below) were readily available in your office, would you administer the test?
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The American Academy of Ophthalmology has reiterated its specific recommendation regarding genetic testing and AMD: “Avoid routine genetic testing for genetically complex disorders like age-related macular degeneration and late-onset primary open-angle glaucoma until specific treatment or surveillance strategies have been shown in 1 or more published clinical trials to be of benefit to individuals with specific disease-associated genotypes. In the meantime, confine the genotyping of such patients to research studies.”
Conversely, in a press release aimed at reaffirming the value of genetic testing for AMD, one manufacturer maintained that its product “is recommended for selective use in combination with clinical findings from a comprehensive eye exam to evaluate a patient’s risk of progression from early and intermediate AMD to advanced AMD with vision loss.”
References:
Perspective
Timothy W. Olsen
Yes, primarily for research purposes. The best use of the test is not for the patient, but for the family member sitting in the room asking about their risk. For the patient who is older than 70 years, the phenotype has nearly an equivalent predictive value, especially when combined with lifestyle and diet. However, the children of such a patient may have genetic variants from either parent, yet they are not old enough to manifest a phenotype (drusen) that enables accurate 10-year predictions. In these cases, the genetic tests offer a much greater predictive value than phenotype.
Timothy W. Olsen, MD
Disclosure: Olsen’s financial disclosures include RO-1AG025392, NIH/NEI: R44 EY016229, RPB unrestricted grant, Emtech Biotechnology grant, Georgia Research Alliance, Dobbs Foundation and Johnson & Johnson.
Perspective
Jay S. Duker
No. Do not order a test unless the results will alter your management.
Jay S. Duker, MD
Disclosure: Duker receives research support from Carl Zeiss Meditec and OptoVue Inc.; he is a consultant for EMD Serono, Neovista, Novartis, QLT, Regeneron and Thrombogenics; he holds stock in Hemera, EyeNetra Inc., Ophthotech and Paloma Pharmaceuticals.
How do you see your practice being impacted over the next 4 years with the continuation of President Barack Obama’s administration?
Perspective
Scott W. Cousins
My practice will be negatively impacted. For Medicare patients, I expect reduced dollar revenue per relative value unit; increased bureaucracy and administrative costs; and decreased autonomy and independent control over patient care decisions. For Medicaid expansion under Obamacare, I expect only a few new patients (predominantly diabetics) who will be added to the practice.
Scott W. Cousins, MD
Disclosure: Cousins is associated with Duke University Eye Center, Durham, N.C. No products or services are discussed.
Perspective
Jay S. Duker
Massachusetts already has universal health care and it works well. Obamacare puts too much control in the hands of large hospital systems whose primary interest is their own self perpetuation, not quality care.
Jay S. Duker, MD
Disclosure: Duker is associated with Tufts Medical Center, New England Eye Center, and Tufts University School of Medicine, Boston. No products or services are discussed.