Optometric and Ophthalmological Management of AMD - Posterior Segment & Ocular Disease Spring 2026

General statements with the Diagnosing and Managing of AMD

The ______ is still the most important thing in diagnosing and management of AMD

clinical picture

General statements with the Diagnosing and Managing of AMD

Everyone with the diagnosis of AMD receives a ________ to use at home

Amsler grid

General statements with the Diagnosing and Managing of AMD

Amsler Grid are ____% effective

50

General statements with the Diagnosing and Managing of AMD

BMI >30 results in a _____% greater AMD risk than a normal BMI

30

General statements with the Diagnosing and Managing of AMD

Since patient's overall health, weight & diet influence progression of AMD, what should you recommend?

diet and exercise as well as UV protection

Early AMD changes

small drusen with a few intermediate drusen

What is the F/U schedule of this Early AMD?

No associated "dramatic" findings (MPOD, FAF, Dark Adaptation, Skin Carotenoids, Normal BMI, and Diet) and Non-Smoker

1 year

What is the F/U schedule of this Early AMD?

One associated finding "dramatically" abnormal, and normal BMI and diet, and Non-Smoker

9 months

What is the F/U schedule of this Early AMD?

Normal associated finding, BMI high, Poor Diet, and Non-Smoker

9 months

What is the F/U schedule of this Early AMD?

One associated finding "dramatically" abnormal, BMI high or poor diet, and Non-Smoker

6 months

What is the F/U schedule?

Smoker

6 months

How must you manage AMD for every patient?

-discuss smoking cessation

-discuss diet (green leafy vegetables, colorful fruits, mega 3 fatty acids, reduction in sat fats)

-discuss exercise

-discuss weight loss if relevant

-discuss UV protection

-All need an Amsler grid

-Fundus photography

Intermediate or Moderate AMD Changes

-5-20 intermediate drusen (or RPE clumps)

-less than 4 large drusen (or large RPE clumps)

-RPE window defects but less than geographic atrophy

How to manage intermediate AMD?

-some sort of imaging must be done (OCT and/or FAF)

-Amsler grid

-AREDS supplement (L&Z w/ no beta carotene & lower zinc dose)

-Fundus photography

If OCT/FAF of intermediate AMD are dramatically worse than expected or if there is a serous detachment, what should be done?

consider referral or a short (4 month) F/U

If OCT/FAF of intermediate AMD does not reveal anything "Dramatic", what should be done?

-6 month F/U if non smoker

-4 month F/U if smoker

Same as for a mild patient, what must be done for EVERY patient with an AMD diagnosis?

-discuss smoking cessation

-discuss diet (green leafy vegetables, colorful fruits, mega 3 fatty acids, reduction in sat fats)

-discuss exercise

-discuss weight loss if relevant

-discuss UV protection

-All need an Amsler grid

-Fundus photography

Advanced AMD Changes

-More than 20 intermediate drusen

-4 or more large drusen

-Geographic atrophy

-Choroidal neovascularization

What is the management plan for Advanced AMD with geographic atrophy, exudative neovascular AMD, or non-exudative neovascular AMD?

REFER to Ophthalmology FOR SURE

What is the management plan for Advanced AMD if there is substantial RPE loss (window defects) but not quite geographic atrophy and/or more than 20 intermediate drusen and/or 4 large drusen?

monitor in 4 months or you can REFER

Do patients with Advanced AMD need an AREDs supplement?

Yes

If you DO NOT REFER an advanced AMD patient, what scans should you do?

OCT is REQUIRED!!! You can also do FAF if you feel like it

Same as for a mild & intermediate patient, what must be done for EVERY patient with an AMD diagnosis?

-discuss smoking cessation

-discuss diet (green leafy vegetables, colorful fruits, mega 3 fatty acids, reduction in sat fats)

-discuss exercise

-discuss weight loss if relevant

-discuss UV protection

-All need an Amsler grid

-Fundus photography

EXAM QUESTION: What is the first-line treatment for Wet AMD?

Intravitreal Anti-VEGF injections

What does the number of injections and the timing of the medication depend on?

-the medication used

-the cost that can be incurred

-patient response

What are the most popular intravitreal injections for Wet AMD?

-Ranibizumab (Lucentis)

-Bevacizumab (Avastin)

-Aflibercept (Eylea)

-Faricimab-Svoa (Vabysmo)

What do the intravitreal injections target?

VEGF

What is the cost of Lucentis?

$2000/dose w/ monthly use

Lucentis may increase risk of what in patients that have had a previous stroke?

increased risk of another stroke

What is the cost of Avastin?

$75/dose

The results showed that monthly Avastin and monthly Lucentis were (more/less/equally) effective to use when patients were followed over the first year in the CATT Study

equally

In the CATT Study, there was a higher rate of systemic adverse effects after 2 years with (Avastin/Lucentis)

Avastin

In the CATT Study, was there any difference in the incidence of CNV in the fellow eye for patient who were previously treated for CNV with either medication, Lucentis or Avastin?

No difference

What were the 5 year results in the CATT Study?

Mean VA declined 3 letters compared to baseline and 11 letters compared to results at 2 years (12.7 letters for Lucentis, 8.8 for Avastin). 50% had VA 20/40 or better and 10% had 20/20 VA

What is the cost of Eylea (Aflibercept)?

$1850 per injection

Clinical trial data showed that Eylea could be administered ________, although the FDA recommends monthly injections for the first three months and then bimonthly schedule

every other month

Has Eylea been shown to be equally efficacious to Ranibizumab?

Yes

What is the benefit of every other month dosing?

-Efficacy and Safety of this drug is similar to Lucentis

-Every other month dosing reduces patient burden compared to a once a month injection of Lucentis

What is the cost of Vabysmo?

$2300/injection

What does Vabysmo target?

VEGF and Angiopoietin-2 (Ang-2)

**in theory, it might be a better drug that the other that are mentioned

What was used PRIOR to Anti-VEGF medications?

Laser photocoagulation

Is laser photocoagulation (Grid, maybe focal) are usually combined with intravitreal injections. What is the cost of laser photocoagulation?

$1700/treatment

What are the disadvantages to laser photocoagulation?

-Visual deficits result

-When used as a stand-alone treatment, neovascular membranes reappeared in up to 55% of treated patients

-NOT a treatment of choice for subfoveal CNVM

______ laser technology reduces energy applied to the retina and therefore reduces visual damage

Micropulse

What is the cost of photodynamic therapy (PDT)?

$1288/treatment

What is photodynamic therapy (PDT) used for?

subfoveal neovasc

How is photodynamic therapy (PDT) used?

-Light activated drug collects in neovasc vessels

-Low powered laser light activates drug, destroys vessels without destroying overlying healthy tissue

-Destruction occurs because free radicals produced that destroy cell membranes leading to thrombosis of neovasc vessels

What is the drug currently being used as photodynamic therapy (PDT)?

Visudyne (Verteprofin)

What will typically appear after the procedure on FA?

choroidal hypofluorescence

What is photodynamic therapy (PDT) very effective for according to Fogt?

pachychoroidal disease

What are the intravitreal injections for geographic atrophy?

-Syfovre

-Izervay

What do Syfovre & Izervay target?

immune response

Are Syfovre & Izervay a cure for geographic atrophy?

No -- just intended to slow the progression