The predictive value of subjective symptoms and clinical signs for the presence of treatment‐requiring exudative age‐related macular degeneration

Abstract

ABSTRACT.Purpose: The introduction of vascular endothelial growth factor inhibitors for the treatment of exudative age-related macular degeneration (AMD) has increased the referral rates of AMD patients with visual symptoms to treating centres considerably. However, a large proportion of the referred patients do not qualify for treatment implying that considerable resources could be saved if these patients could be identified on the basis of the clinical data available in the referring nonspecialized setting. Methods: A prospective observational study of 1682 consecutive patients referred with suspicion of exudative AMD qualifying for intravitreal angiostatic treatment. On the basis of the structured interviewing about symptoms, ophthalmoscopy, optical coherence tomography scanning, and fluorescein angiography, the patients were divided into two groups: one qualifying for and another not qualifying for treatment. Multiple logistic regression was used to identify independent parameters predicting the need for treatment. Results: The presence of metamorphopsia, dyschromatopsia, retinal haemorrhages and exudates, central retinal thickness, and the absence of micropsia were highly significant individual determinants of treatment-requiring AMD. Sudden onset and worsening of symptoms and the presence of a central dark spot covaried with the occurrence of retinal haemorrhages, whereas reduced visual acuity and blurred vision covaried with the presence of both haemorrhages and exudates. Conclusion: Patients with treatment-requiring AMD can be reliably identified by questioning about the presence of metamorphopsia and dyschromatopsia and the absence of micropsia, combined with ophthalmoscopical detection of retinal haemorrhages and exudates. This information may improve the triage of patients considered for referral.

Validation of a novel functional test for assessing metamorphopsia using epiretinal membranes as a model

“…Accurate measurement of metamorphopsia can provide crucial information to guide clinicians in the management of vitreomacular interface diseases 27 . Although conditions such as exudative age-related macular degeneration use techniques such as the Amsler grid for screening for the development of acute onset functional changes 28 , there is a potential clinical benefit for the quantification of visual functions in chronic or slowly progressive diseases such as iERMs. Our approach was demonstrably better at detecting metamorphopsia associated with iERMs compared to the most widely adopted clinical test, the Amsler grid.…”

Age, sex, and type of medication predict the effect of anti-VEGF treatment on central retinal thickness in wet age-related macular degeneration

“…This adds to a previous study of clinical signs and symptoms that can predict the need for anti-VEGF treatment in newly referred patients with suspected wAMD. 9 The study has a number of methodological strengths. It was possible to consider approximately 170 patients per variable studied, which is a strong design for a multiple linear regression analysis.…”

Self‐recognition of recurrences among patients with exudative age‐related macular degeneration

“…Here, we examined visual acuity as the primary outcome. The degree of metamorphopsia, which may reflect disease activity in exudative AMD, was not estimated . We hope further studies may reveal the characteristics of patients who can and cannot sensitively recognise metamorphopsia.…”