Age-related macular degeneration: Updates for general practitioners

Age-related macular degeneration (AMD) is the leading cause of legal blindness in Australians over 50 years, accounting for 60% of all blindness. AMD progresses from asymptomatic early and intermediate stages to late neovascular ('wet') or atrophic ('dry') forms that cause irreversible central vision loss. Age and family history are the strongest risk factors, while smoking, poor diet and cardiovascular disease are key modifiable contributors.

To raise awareness of AMD in general practice and provide some advice on what general practitioners (GPs) can do to assist in early detection and prevention with an ageing population. GPs can examine the macula in at-risk adults, as well as encourage smoking cessation, a Mediterranean-style diet, regular exercise, and Age- Related Eye Disease Study 2 (AREDS2) supplementation for intermediate disease. Sudden distortion or vision loss requires urgent ophthalmology referral for possible neovascular AMD.

Intravitreal anti-VEGF (vascular endothelial growth factor) therapy remains the mainstay for wet AMD, while complement inhibitors show promise for geographic atrophy. Emerging gene, sustained-delivery and laser therapies might soon reduce treatment burden and improve adherence.