This article is more than 5 years old. Information may no longer be current.
Give your AMD patients hope
Click Here to Manage Email Alerts
We've all seen it too many times. An elderly patient complains of reduced vision. Your exam reveals very little refractive change, clinically significant cataract and questionable age-related macular degeneration (AMD). You counsel the patient, recommend phacoemulsification with IOL implantation and the patient enjoys improved vision. For the time being.
In the years to follow your patient reports more blurred vision. At first it is difficulty reading, then driving and finally being able to enjoy their grandchildren's facial expressions. They ask if their glasses can be made stronger, whether the cataracts have returned and, most importantly, what can be done. You counsel the patient and assure them AMD never results in total blindness. Some consolation.
No "magic bullet"
No doubt, despite the miracles of ophthalmic medicine, AMD remains one of our greatest challenges. More than 1 million Americans suffer from AMD, and it is estimated an additional 10 million will develop it over the next decade. Furthermore, the impact of AMD is far reaching. It deprives many of functional vision, threatens their independence and is a flagrant reminder of aging and vulnerability. AMD can be demoralizing for the patient and, ultimately, his or her family.
Central to the AMD dilemma is the fact we lack a therapeutic "magic bullet." This does not, however, exonerate us from providing the most contemporary care possible. To this end, many of us should adopt a more proactive approach to AMD management.
Preventative measures
First, and foremost, prophylaxis is essential. We know risk factors such as familial history, soft drusen and circulatory disease predispose patients to AMD. For these individuals, a frank conversation regarding preventative measures is essential. Furthermore, at-risk patients should be aggressively monitored, rather than waiting for overt symptoms and ophthalmoscopic indications of AMD. Macular visual field, contrast sensitivity, Amsler grid, color vision, glare recovery and stereoscopic ophthalmoscopy should supplement our traditional ophthalmic examination techniques. Addi-tionally, at-home Amsler grid evaluation is critical.
Early intervention
Second, where appropriate, early intervention is paramount. True, this is controversial. On one hand, it's our responsibility to protect patients from anecdotal treatments that are, at best, useless and, at worst, dangerous. On the other hand, for many time is of the essence, and certain treatment strategies just make sense. Recommend ations regarding ultraviolet protection, diet and supplementation and general health wellness are imperative.
Third, a more aggressive optical management approach is necessary. Whereas providing increased magnification through a greater spectacle add is a reasonable first line approach, it's sometimes not enough. For these patients, magnifiers, telemicroscopes and video camera systems should be evaluated. True, these devices are not as convenient as traditional spectacles, but they often provide patients with greater functional vision and independence. Fur ther more, these services need not be provided in every optometric practice. It's far better care to refer to a low vision specialist than to adopt a "nothing more can be done" attitude.
Maintain hope
The final component of successful AMD management involves a little hope. Granted, we should never mislead patients with a false hope of a miracle cure. However, we should also be careful not to extinguish any sense of hope our AMD patients have. Indeed, when you consider the advances of macular photocoagulation, photodynamic therapy and even macular translocation surgery, it is evident the future holds many possibilities for AMD treatment.
Undoubtedly, the advances in AMD management over the past two decades pale in comparison to those made in cataract, glaucoma, amblyopia and contact lens management. However, we live in an era of prolific AMD research, in which proactive management is beneficial and in which benign neglect is no longer acceptable. n