Age-Related Macular Degeneration

Publication Date: January 1, 2020


Although an estimated 80% of age-related macular degeneration (AMD) patients have non-neovascular or atrophic AMD, the neovascular form is responsible for the majority of the severe central visual acuity (VA) loss associated with AMD.

The primary risk factors for the development of advanced AMD include increasing age, northern European ancestry, and genetic factors. Cigarette smoking is the main modifiable risk factor that has been consistently identified in numerous studies. Smoking cessation is strongly recommended when advising patients who have AMD or are at risk for AMD. The routine use of genetic testing is not recommended at this time.

A meta-analysis of 10 studies found that the use of aspirin was not associated with an increased risk of AMD. Therefore, patients who have been instructed by a physician to use aspirin should continue to use it as prescribed.

Antioxidant vitamin and mineral supplementation as per the Age-Related Eye Disease Study (AREDS2) should be considered in patients with intermediate or advanced AMD. There is no evidence to support the use of these supplements for patients who have less than intermediate AMD and no evidence of any prophylactic value for family members without signs of AMD.

Fluorescein angiography, optical coherence tomography (OCT), and optical coherence tomography angiography (OCTA) are useful diagnostic tests in clinical practice to detect new or recurrent neovascular disease activity and guide therapy.

In patients with neovascular AMD, early detection and prompt treatment improves the visual outcome. Intravitreal injection therapy using anti-vascular endothelial growth factor (VEGF) agents (e.g., aflibercept, bevacizumab, and ranibizumab) is the most effective way to manage neovascular AMD and represents the first line of treatment. Symptoms suggestive of postinjection endophthalmitis or retinal detachment require prompt evaluation. (, , )

Recommendation Grading




Age-Related Macular Degeneration

Authoring Organization

Publication Month/Year

January 1, 2020

Supplemental Implementation Tools

Document Type


External Publication Status


Country of Publication


Document Objectives

Identify patients at risk of visual loss related to AMD. Educate patients and their families about the disease, risk factors, and preventive measures. Minimize or reverse visual loss and functional impairment in these patients through appropriate detection, self-assessment, treatment, and follow-up examinations. Help patients identify expert physicians and resources needed to facilitate improvement in vision

Target Patient Population

Patients 50 years of age and older with or without visual problems

Inclusion Criteria

Adult, Older adult

Health Care Settings

Ambulatory, Emergency care, Hospital, Outpatient

Intended Users

Optometrist, optician, nurse, nurse practitioner, physician, physician assistant


Diagnosis, Management

Diseases/Conditions (MeSH)

D008268 - Macular Degeneration, D000071700 - Cone-Rod Dystrophies, D005128 - Eye Diseases, D015785 - Eye Diseases, Hereditary


macular degeneration, Neovascularization, hereditary macular dystrophies

Source Citation

Flaxel, C. J., Adelman, R. A., Bailey, S. T., Representative, R. S., Fawzi, A., Representative, M. S., … Ying, G. (2019). Age-Related Macular Degeneration Preferred Practice Pattern®. Ophthalmology. doi:10.1016/j.ophtha.2019.09.024

Supplemental Methodology Resources

Data Supplement, Methodology Supplement


Number of Source Documents
Literature Search Start Date
March 1, 2018
Literature Search End Date
June 1, 2019