Clinical update

New guidelines to diagnose and treat age-related macular degeneration

The National Institute for Health and Care Excellence has produced new guidelines on age-related macular degeneration in a bid to prevent sight loss and improve diagnosis

The National Institute for Health and Care Excellence has produced new guidelines on age-related macular degeneration in a bid to prevent sight loss and improve diagnosis

NICE says there is robust evidence that visual loss is linked with delays in diagnosis. Picture: Science Photo Library

Essential facts

Age-related macular degeneration (AMD) is the term given to ageing changes without any other obvious cause, that occur in the central area of the retina (macula), sometimes with new blood vessel formation, which is known as wet AMD and is the most common form of macular degeneration.

AMD is the most common cause of visual impairment in the developed world and affects more than 600,000 people in the UK. AMD is a painless condition that generally leads to the gradual impairment of vision, but it can sometimes cause a rapid reduction in sight. It predominantly affects the central vision, which is used for reading and recognising faces. Almost one in 20 people aged 65 and over are affected, rising to more than one in ten of those aged 80 and over.

What’s new?

National Institute for Health and Care Excellence guidance on AMD aims to improve the speed that people are diagnosed and treated to prevent loss of sight. It sets out how AMD should be classified, diagnosis and referral pathways, and the pharmacological options that should be considered. Patients should be given extensive information about the condition and its potential progress.

Signs and symptoms

Difficulty reading small print even with reading glasses, colours becoming less vibrant, straight lines appearing wavy or distorted and vision becoming less clear are signs. Symptoms in wet AMD can come on more rapidly and need to be treated as soon as possible to stop it getting worse.

Causes and risk factors

AMD is caused by the photoreceptor cells in the macula becoming damaged.

It is more common in people who are older, have a family history of AMD, are obese, smoke, have high blood pressure, a diet high in fat and low in omega-3 and omega-6 fatty acids, vitamins, carotenoids and minerals, and who do little exercise.

How you can help your patient

  • Provide information to people with AMD and their carers on how it can progress, complications, vision standards for driving and healthy lifestyle advice – including quitting smoking.
  • Be aware that people with AMD are at an increased risk of depression. Identify and manage the depression.
  • Offer certification of visual impairment to all people with AMD as soon as they become eligible, even if they are still receiving active treatment.

Expert comment

Mary Freeman is nurse consultant in ophthalmology at Sheffield Teaching Hospitals NHS Foundation Trust

‘Age-related macular degeneration (AMD) is a progressive disease and nurses should be aware of the visual symptoms so they can direct the older person to gain prompt assessment and treatment.

'Raising awareness of the symptoms and emphasising the need to access services promptly when deterioration or distortion in vision is experienced are vital.

‘Nurses should also understand the effect AMD may have on an individual’s ability to carry out activities of daily living, and not all symptoms of AMD can be managed by pharmacological interventions. An appreciation of what help is available, and where, would greatly improve patient care and experience.

‘Psychological and practical support through low vision rehabilitation can help people live with visual loss and maintain their independence. Nurses should be aware that people with AMD have an increased risk of depression so strategies for optimising existing visual performance should be considered.’


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