Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
Adv Exp Med Biol. 2021;1256:295-314. doi: 10.1007/978-3-030-66014-7_12.
Age-related macular degeneration (AMD) remains a leading cause of blindness worldwide. The assessment and management of patients with this condition has evolved in the last decades. In this chapter, current standards for diagnosis, follow-up, and treatment of patients with AMD are reviewed and summarized. Namely, we highlight how current assessment has moved from conventional ophthalmoscopy and fluorescein angiography testing to a multimodal approach, and its important advantages. Alternatives to visual acuity for functional assessment of patients with AMD are also presented. Regarding strategies for follow-up and treatment, we provide specific information for the different stages (i.e., early, intermediate, and late) and forms (for example, choroidal neovascularization and geographic atrophy) of AMD. Specifically, we discuss the relevance and options for self-monitoring and non-pharmacological interventions. Additionally, a summary of the important trials (both on exudative and non-exudative AMD) that have helped inform clinical practice is provided, including data on antiangiogenic agents currently available, and outcomes of the different regimens that have been studied. The influence of advances in imaging on treatment strategies is also discussed.In summary, this chapter is a resource for all clinicians engaged in providing state of the art care for patients with AMD, and can help improve diagnosis, management, and outcomes of individuals with this blinding condition.
年龄相关性黄斑变性（AMD）仍然是全球致盲的主要原因。在过去几十年中，这种疾病的评估和管理已经发生了变化。在本章中，我们回顾并总结了 AMD 患者的诊断、随访和治疗的当前标准。具体而言，我们强调了当前评估方法如何从传统的眼底镜检查和荧光素血管造影测试发展为多模态方法，以及其重要优势。我们还介绍了用于评估 AMD 患者功能的视力替代方法。关于随访和治疗策略，我们为 AMD 的不同阶段（例如早期、中期和晚期）和形式（例如脉络膜新生血管和地图状萎缩）提供了具体信息。具体而言，我们讨论了自我监测和非药物干预的相关性和选择。此外，我们还提供了有助于指导临床实践的重要试验（包括渗出性和非渗出性 AMD）的总结，包括当前可用的抗血管生成药物的数据，以及已研究的不同方案的结果。还讨论了成像技术的进步对治疗策略的影响。总之，本章是所有致力于为 AMD 患者提供最新治疗的临床医生的资源，可以帮助改善该致盲性疾病患者的诊断、管理和预后。
