The primary care physician should consider the diagnosis of neovascular age-related macular degeneration (AMD) in an middle-aged or elderly patient presenting with visual complaints. Screening for the condition should be included as part of the routine physical examination.
Assessment:
(1) age > 50 years
(2) new ocular symptoms
(3) ophthalmoscopic examination
Ocular symptoms - one or more of the following:
(1) decreased visual acuity using an eye chart
(2) recent abnormality detected on a Amsler grid
(3) sudden new distortion in vision
(4) blank spot in vision
where:
• The Amsler grid shows black lines against a white background. Findings seen in neovascular age-related macular degeneration include distortion/bending of the straight lines (metamorphopsia) and/or scotoma (decreased vision in the center of the visual field sometimes perceived as a black spot).
• Other symptoms mentioned in AMD include: difficulty reading, difficulty recognizing faces, flickering or flashing lights, showers of floaters, difference in color recognition between eyes, loss of contrast sensitivity and light glare.
Directed findings on ophthalmoscopy:
(1) macular scar
(2) drusen
(3) macular hemorrhage
(4) lipid deposits
Refer to an ophthalmologist if:
(1) new ocular symptoms present
(2) macular hemorrhage with drusen seen on ophthalmoscopic examination
(3) retinal lipid deposits with drusen seen on ophthalmoscopic examination
(4) unable to determine if drusen present
Continue to monitor the patient if:
(1) there are no new ocular symptoms, AND
(2) the ophthalmoscopic examination is normal or shows macular scar or drusen
If the person has drusen, then:
(1) consider oral supplementation with anti-oxidants and zinc
(2) educate the patient about self-monitoring, testing one eye at a time
(3) refer to an ophthalmologist for education
