The Royal College of Ophthalmologists interim recommendations for the management of patients with age-related macular degeneration

Age-related macular degeneration (AMD) causes severe visual loss and is the commonest cause of blindness in persons ⩾50 years old in the western world.^{1, 2, 3, 4} Two main forms of AMD occur: dry and wet. The dry form accounts for 90%, whereas the wet form occurs in 10% of all AMD. The severe visual loss in 90% of cases is due to the wet form of AMD, which is characterized by choroidal neovascularisation (CNV). The majority of CNVs occur subfoveally.⁵ There is evidence that angiogenic factors, especially vascular endothelial growth factor (VEGF) and fibroblastic growth factor play a significant role in the development and maintenance of CNV. High levels of VEGF have been demonstrated in CNV surgically excised from humans or animal experimental CNV.^{6, 7}

It was previously estimated by research commissioned by the Macular Disease Society (MDS) (Fletcher A, Donoghue M, Owen C. Low Vision Services for People with Age-Related Macular Degeneration in the UK: A Review of Service Need and Provision. Macular Disease Society Report, June 2001) that 21 000 new cases of wet AMD occurred in the United Kingdom each year. Current estimates by the Royal National Institute for the Blind (RNIB) and the National Institute of Clinical Excellence (NICE) indicate that there may be 26 000 patients eligible for the new anti-VEGF treatments in the United Kingdom each year (compared with 7000 currently eligible for photodynamic therapy (PDT) (NICE: HTA Ranibizumab and Pegaptanib for the treatment of AMD. Final Scope. 25 April 2006; http://www.nice.org.uk).

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