Macular clinical case histories

Richard Newsom describes some recent AMD presentations and asks you to decide upon the urgency of referral. His answers will be published next week. This is not a CET module

Appropriate referral of patients with wet AMD has been recently highlighted in a report from the UK Macular Society and Novartis Pharmaceuticals.

They found that many patients were inappropriately referred through the medical, optometric and ophthalmology system. Some patients waited several months before specialist opinion was given. Hold-ups occurred at GP surgeries and general eye clinics, and time was wasted by referring patients from one specialist centre to another. This can clearly lead to visual loss for patients and some patients were therefore unable to be treated once they arrived at the macular clinic.
NICE has stipulated that only patients with classic choroidal neovascularisation (CNV) and vision better than 6/60 can receive photodynamic therapy (PDT) on the NHS.

There is considerable evidence that small, active occult lesions also do well. However, this evidence was not available when the initial decisions were made.  This group of patients needs urgent referral to the macular clinic.

It is therefore useful to find out where the local macular clinic is based, and whether it is able to offer PDT treatment.  Never assume that the closest or largest eye hospital is able to offer specialised AMD treatment.

Please look at these short patient histories along with the adjacent colour images and note a decision whether to  refer to your local macular clinic: