A concise co-management reference for detecting, monitoring and referring age-related macular degeneration. We value shared care and welcome your ongoing role in surveillance between specialist reviews.
Risk stratification & modification
First-degree relatives carry a three- to four-fold increased lifetime risk (heritability 45–70%). Genetic testing (CFH, ARMS2/HTRA1) is not recommended for routine individual risk stratification — it rarely changes management. Nonetheless, next generation or sibling risk stratification can be assisted by genome wide association testing and probe based Single Nucleotide Polymorphism genotyping (MacuCheck: Genomics for Life) to identify higher risk variants. Red Flags are systemic associations: smoking (×2 risk), untreated hypertension, and chronic kidney disease (shared CFH complement/vascular mechanisms). This reinforces advice pertaining to early adoption of Mediterranean/pescetarian diets, adequate omega-3 (DHA/EPA) intake, lifestyle modification and AREDS2 for intermediate or advanced disease.
Monitoring & imaging
- OCT + Fundus Autoflourescence at baseline and interval review for intermediate AMD — to track drusen volume, drusenoid PED, and nascent/incomplete RORA.
- Reticular pseudodrusen (RPD) — a high-risk phenotype; lower your threshold to refer early and monitor more frequently with Amsler grids.
- Watch for conversion biomarkers — intraretinal/subretinal fluid, subretinal hyper-reflective material, new haemorrhage.
- Home monitoring — Amsler grid refrigerator magnets monocular checks; counsel on metamorphopsia and acute central step changes.
When to refer
URGENT (same / next day) — suspected active CNV: new metamorphopsia or central scotoma, sub/intraretinal fluid, macular haemorrhage, or acute unexplained drop in central acuity.
ROUTINE (baseline / surveillance) — intermediate AMD (large drusen ± pigmentary change) for baseline OCT + Fundus autoflourescence and risk counselling; RPD; macula threatening geographic atrophy for assessment of emerging complement-inhibitor therapy; diagnostic uncertainty.
What we offer
Same day intravitreal anti-VEGF with treat-and-extend regimens for neovascular AMD, rapid multimodal imaging (OCT/OCT-A/FFA), and access to complement-inhibitor therapy (e.g. pegcetacoplan) for geographic atrophy. We offer to provide prompt same day review, written feedback after initial visit, and a shared surveillance plan.
Suspected wet AMD, emergent vision loss, retinal detachment or endophthalmitis — please phone the rooms directly on the below number for same or next-day review.
