Table 5 Brief overview of NICE advice for management of neovascular age-related macular degeneration [12]

From: Action on neovascular age-related macular degeneration (nAMD): recommendations for management and service provision in the UK hospital eye service

Referral and diagnosis:
People with suspected active nAMD must be urgently referred to a macula service, normally within 1 working day.
People with suspected active nAMD should be offered OCT and FFA to confirm the diagnosis if OCT alone does not exclude neovascular disease.
Pharmacological management with antiangiogenic therapy:
Treatment should be offered within 14 days of referral to the macula service for eyes with a confirmed diagnosis of active nAMD for which antiangiogenic therapy is recommended.
In eyes with VA of 6/96 or worse (≤25 letters), anti-VEGF treatment for nAMD may be considered only if a visual function benefit is expected (e.g., if the affected eye is the person's better-seeing eye). 
Practitioners are reminded that anti-VEGF treatment for eyes with nAMD and VA better than 6/12 (≥70 letters) is clinically effective and may be cost effective depending on the regimen used, although not currently recommended.
Practitioners are advised not to offer PDT alone for active nAMD. NICE recommends that PDT is only offered as an adjunct to anti-VEGF therapy as second-line treatment for active nAMD in the context of a randomised controlled trial.
Intravitreal corticosteroids should not be offered as an adjunct to anti-VEGF therapy for active nAMD.
Switching and stopping antiangiogenic therapy:
Practitioners may consider switching anti-VEGF treatment for people with active nAMD if there are practical reasons for doing so (e.g., if a different medicine can be given in a regimen the person prefers) although the clinical benefits are likely to be limited.
Observation without giving anti-VEGF treatment is recommended if the disease appears stable.
Stopping anti-VEGF treatment should be considered if the eye develops severe, progressive loss of VA despite treatment and treatment discontinued if the nAMD is inactive or there is no prospect of functional improvement.
Non-pharmacological management of AMD: psychological therapies and support strategies:
People with AMD and visual impairment are at an increased risk of depression and many may have other significant comorbidities.
Practitioners are advised to identify and manage depression according to the NICE guideline on depression in adults with a chronic physical health problem.a
Guidance on optimising care for adults with multiple long-term conditions is available in the NICE guideline on multimorbidity.b
Certification of visual impairment should be offered to all people with AMD as soon as they become eligible, even if they are still receiving active treatment, with referral to low-vision services considered for those with AMD causing visual impairment.
Monitoring of active nAMD, inactive nAMD and those with AMD discharged from hospital services:
Active nAMD: offer ongoing monitoring with OCT for both eyes.
Inactive nAMD: review both eyes at monitoring appointments.
Discharged:
° Patients should be advised to self-monitor their AMD, consult their primary eye care professional if their vision changes or new symptoms emerge (e.g., blurred or grey patch in their vision, straight lines appearing distorted or objects appearing smaller than normal) and continue to attend routine sight-tests with their community optometrist; and
° A clear local pathway should be agreed covering ongoing management and re-referral when necessary following discharge to primary care.
Information and support:
Information in accessible formats should be provided for people with nAMD, allowing sufficient time to discuss the concerns and questions that the persons have about their diagnosis, treatment and prospects for their vision. Peer support is encouraged.
Patients should be counselled about the possibility of developing visual hallucinations associated with retinal dysfunction (Charles Bonnet syndrome), a condition that typically improves but can last several years.
  1. Anti-VEGF anti-vascular endothelial growth factor, FFA fundus fluorescein angiography, nAMD neovascular age-related macular degeneration, OCT optical coherence tomography, PDT photodynamic therapy, VA visual acuity
  2. aAvailable at: https://www.nice.org.uk/guidance/cg91
  3. bAvailable at: https://www.nice.org.uk/guidance/ng56
  4. See ref. [12]. NICE © 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-of-rights)
  5. NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/publication.