The predictive value of subjective symptoms and clinical signs for the presence of treatment-requiring exudative age-related macular degeneration
Article first published online: 14 JAN 2011
© 2011 The Authors. Acta Ophthalmologica © 2011 Acta Ophthalmologica Scandinavica Foundation
Volume 90, Issue 5, pages 471–475, August 2012
How to Cite
Hessellund, A., Larsen, D. A. and Bek, T. (2012), The predictive value of subjective symptoms and clinical signs for the presence of treatment-requiring exudative age-related macular degeneration. Acta Ophthalmologica, 90: 471–475. doi: 10.1111/j.1755-3768.2010.02074.x
- Issue published online: 27 JUL 2012
- Article first published online: 14 JAN 2011
- Received on July 24th, 2010. Accepted on November 14, 2010.
- exudative age-related macular degeneration;
- intravitreal angiostatic treatment;
- risk factors;
- specialized centres triage
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.