Recommended Treatment

Diagnoses Eligible for Treatment

Follow-up Recommendations

Observation with no medical or surgical therapies (A:I)

No clinical signs of AMD (AREDS category 1)

Early AMD (AREDS category 2)

Advanced AMD with bilateral subfoveal geographic atrophy or disciform scars

As recommended in the Comprehensive Adult Medical Eye Evaluation PPP (A:III)

Return exam at 6 to 24 months if asymptomatic or prompt exam for new symptoms suggestive of CVN (A:III)

No fundus photos or fluorescein angiography unless symptomatic (A:I)

Antioxidant vitamin and mineral supplements as recommended in the AREDS reports (A:I)

Intermediate AMD (AREDS category 3)

Advanced AMD in one eye (AREDS category 4)

Monitoring of monocular near vision (reading/Amsler grid) (A:III)

Return exam at 6 to 24 months if asymptomatic or prompt exam for new symptoms suggestive of CVN (A:III)

Fundus photography as appropriate

Fluorescein angiography if there is evidence of edema or other signs and symptoms of CVN

Thermal laser photocoagulation surgery as recommended in the MPS reports (A:I)   

Extrafoveal classic CNV, new or recurrent

Juxtafoveal classic CNV

May be considered for new or recurrent subfoveal CNV if the lesion is less than 2 MPS disc areas and the vision is 20/125 or worse, especially if PDT is contraindicated or not available

May be considered for juxtapapillary CVN

Return exam with fluorescein angiography approximately 2 to 4 weeks after treatment, and then at 4 to 6 weeks and thereafter depending on the clinical and angiographic findings (A:III)

Retreatments as indicated

Monitoring of monocular near vision (reading/Amsler grid) (A:III)

PDT with verteporfin as recommended in the TAP and VIP reports (A:I)

Subfoveal CNV, new or recurrent, where the classic component is  >50% of the lesion and the entire lesion is <5400 microns in greatest linear diameter

Occult CNV may be considered for PDT with vision <20/50 or if the CVN is <4 MPS disc areas in size when the vision is >20/50

Return exam approximately every 3 months until stable, with retreatments as indicated (A:III)

Fluorescein angiography or other imaging as indicated

Monitoring of monocular near vision (reading/Amsler grid) (A:III)

Pegaptanib sodium intravitreal injection as recommended in pegaptanib sodium literature (A:I)

Subfoveal CNV, new or recurrent, for predominantly classic lesions <12 MPS disc area in size

Minimally classic, or occult with no classic lesions where the entire lesion is <12 disc areas in size, subretinal hemorrhage associated with CVN comprises <50% of lesion, and/or there is lipid present, and/or the patient has lost 15 or more letters of visual acuity during the previous 12 weeks

Patients should be instructed to report any symptoms suggestive of endophthalmitis without delay, including eye pain or increased discomfort, worsening eye redness, blurred or decreased vision, increased sensitivity to light, or increased number of floaters (A:III)

Return exam with retreatments every 6 weeks as indicated (A:III)

Monitoring of monocular near vision (reading/Amsler grid) (A:III)

Ranibizumab intravitreal injection 0.5 mg as recommended in ranibizumab literature (A:I)

Subfoveal CNV

Patients should be instructed to report any symptoms suggestive of endophthalmitis without delay, including eye pain or increased discomfort, worsening eye redness, blurred or decreased vision, increased sensitivity to light, or increased number of floaters (A:III)

Return exam with retreatments every 4 weeks as indicated (A:III)

Monitoring of monocular near vision (reading/Amsler grid) (A:III)

Bevacizumab intravitreal injection as described in published reports (A:III) 

The ophthalmologist should provide appropriate informed consent with respect to the off-label status (A:III)

Subfoveal CNV

Patients should be instructed to report any symptoms suggestive of endophthalmitis without delay, including eye pain or increased discomfort, worsening eye redness, blurred or decreased vision, increased sensitivity to light, or increased number of floaters (A:III)

Return exam with retreatments every 4 to 8 weeks as indicated (A:III)

Monitoring of monocular near vision (reading/Amsler grid) (A:III)