Early detection and treatment of neovascular age-related macular degeneration.

BACKGROUND The neovascular form of age-related macular degeneration (AMD) can rapidly lead to severe loss of central vision and adversely affect the patient's quality of life. During the 1990s the only proven treatment for neovascular AMD was laser photocoagulation. Only a minority of patients are eligible to receive this treatment, however, and the treatment itself can cause acute retinal damage with immediate vision loss. Verteporfin therapy is a new treatment option involving photodynamic therapy that was recently shown to be relatively safe and effective in reducing the risk of vision loss in selected cases. METHODS Recent literature was reviewed on management of choroidal neovascularization caused by AMD that proved beneficial in large-scale randomized clinical trials. These studies were selected through a MEDLINE search of files from 1982 to the present using the keywords "randomized clinical trials," "choroidal neovascularization," and "age-related macular degeneration," as well as through personal knowledge of recently completed trials. RESULTS AND CONCLUSIONS Primary care physicians can effect good treatment outcomes by detecting early signs of AMD and educating patients about the necessity of prompt referral to an ophthalmologist. Immediate referral is increasingly important because, compared with laser photocoagulation, current photodynamic therapy with verteporfin is applicable to more patients. Greater patient awareness of neovascular AMD and the importance of self-testing of vision can also be communicated to patients in primary care.