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
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 stratification — it rarely changes management. Flag systemic associations: smoking (×2 risk), untreated hypertension, and chronic kidney disease (shared complement/vascular mechanisms). Reinforce a Mediterranean/pescetarian diet, omega-3 (DHA/EPA) intake and AREDS2 for intermediate or advanced disease.
Monitoring & imaging
- OCT at baseline and interval review for intermediate AMD — track drusen volume, drusenoid PED, and nascent/incomplete RORA.
- Reticular pseudodrusen (RPD) — a high-risk phenotype; lower your threshold to refer and monitor.
- Watch for conversion markers — intraretinal/subretinal fluid, subretinal hyper-reflective material, new haemorrhage.
- Home monitoring — Amsler grid per eye; counsel on metamorphopsia and acute central change.
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 and risk counselling; RPD; geographic atrophy for assessment of emerging complement-inhibitor therapy; diagnostic uncertainty.
What we offer
Intravitreal anti-VEGF with treat-and-extend regimens for neovascular AMD, multimodal imaging (OCT/OCT-A/FFA), and access to complement-inhibitor therapy (e.g. pegcetacoplan) for geographic atrophy. We provide prompt review, written feedback after each visit, and a shared surveillance plan.
