Mr Samer Elsherbiny Consultant Ophthalmologist January 2017 Introduction Agerelated macular degeneration ARMD The disease and its management Future trends Service provision Current service ID: 908350
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Slide1
Age-related macular degeneration: an update
Mr
Samer
Elsherbiny
Consultant Ophthalmologist
January 2017
Slide2Introduction
Age-related macular degeneration (ARMD)
The disease and its management
Future trends
Service provision
Current service
Future possibilities
Slide3Age-related macular degeneration
Slide4Age-related macular degeneration
Slide5Age-related macular degeneration
Slide6Age-related macular degeneration
Ageing change
Dry
Wet
Slide7Slide8Slide9Age-related macular degeneration
Epidemiology
Leading cause of irreversible visual loss Western World (age 55+)
Dry and wet forms: 2 thirds of UK CVI
450 new wet ARMD per million per year
Prevalence:
4.8% for >65
12.2% for >80
Predicted to increase by 33% between 2010 and 2020
Slide10Age-related macular degeneration
Diagnosis
History
Clinical findings
Differential diagnosis
Diagnostic imaging
Slide11Age-related macular degeneration
Diagnostic imaging
Visual Acuity
Ophthalmoscopy
Angiography
Ocular Coherence Tomography
Others where needed (Electrophysiology)
New technologies
Slide12Age-related macular degeneration
Slide13Slide14Amsler Grid (recording chart)
Slide15Slide16Slide17Age-related macular degeneration
Management
Prevention
Treatment
Slide18Slide19Age-related macular degeneration
Management
Treatment
Early referral (days)
Intravitreal
injections for those eligible (how many??)
Long-term follow up (how long??)
Counselling/support/CVI/other pathology
Slide20Age-related macular degeneration
Ranibizumab
(
Lucentis
)
Aflibercept
(
Eylea
)
Photodynamic therapy with
verteporfin
(visudyne
) (subtypes)
Bevacizumab
(
avastin
) (subtypes)
Slide21Age-related macular degeneration
Management
Prevention
Treatment
Surgery
Radiotherapy
Slide22Age-related macular degeneration
Management
Prevention
Systemic
Lifestyle/ Environmental
Other
Slide23Age-related macular degeneration
Management
Prevention
Systemic
Hypertension
Coronary and Vascular disease
Statins
Diabetes
Genetics
Slide24Age-related macular degeneration
Management
Prevention
Lifestyle/ Environmental
Smoking
Alcohol
Diet/ Nutrition
Anti-oxidants;
lutein
;
zeaxanthine
Polyunsaturated fats
Obesity
Exercise
Slide25Age-related macular degeneration
Management
Prevention
Other
Cataract Surgery
Sunlight exposure
Gender (sex hormones)
Race/ethnicity
Educational status/social class
Slide26Age-related macular degeneration
Future trends
New drugs
Beware dry macular
degenration
New drug delivery devices
New diagnostics (better structural and functional analysis)
Rehabilitation of
existing patients
New ways of working??
Slide27Age-related macular degeneration
Slide28Age-related macular degeneration
Slide29Age-related macular degeneration
Slide30Age-related macular degeneration
Slide31Age-related macular degeneration
New ways of working???
Challenges:
New to follow up ratios? (can you guess???)
Patient pathway
IT infrastructure
Who is responsible for what
Who is paid what
Information governance
Slide32Age-related macular degeneration
Extended roles in secondary care
“Virtual clinics”
Optometrists
GP with specialist interest
“Catchment area”/ CCG solutions
Vanguards
Slide33Summary
Age-related macular degeneration (ARMD)
The disease and its management
Future trends
Service provision
Current service
Future possibilities
Slide34References
https://www.rcophth.ac.uk/wp-content/uploads/2014/12/2013-SCI-318-RCOphth-AMD-Guidelines-Sept-2013-FINAL-2.pdf
https://www.rcophth.ac.uk/wp-content/uploads/2015/04/2010-SCI-048-AMD-Electronic-Referral-Form-edited.pdf
Slide35References
https://www.rcophth.ac.uk/publications/nhs-england-conference-7-june-2016-address-demand-and-capacity-pressures-in-the-hospital-eye-service/
https://www.rcophth.ac.uk/2016/06/ccgs-urged-to-tackle-backlogs-at-nhs-england-eye-health-summit/
Slide36References
https://www.rcophth.ac.uk/wp-content/uploads/2014/12/2013-SCI-318-RCOphth-AMD-Guidelines-Sept-2013-FINAL-2.pdf
https://www.rcophth.ac.uk/2016/05/rcophths-three-step-plan-to-reduce-risk-for-eye-patients/