Improving patient outcomes: role of the primary care optometrist in the early diagnosis and management of age-related macular degeneration

Lei Liu, Mark SwansonSchool of Optometry, University of Alabama at Birmingham, Birmingham, AL, USAAbstract: Not long ago, the management of age-related macular degeneration (AMD) was confined to rehabilitating whatever vision had not been damaged by the disease. The recent successes of the anti-vascular endothelial growth factor agents and the antioxidant clinical trials have revolutionized AMD treatment. For the first time, there is realistic hope that the progression of AMD can be slowed down or stopped and near normal vision can be preserved. Developments in new vision tests, imaging modalities, and genetic testing have greatly improved the chance of detecting the onset of AMD and choroidal neovascularization. However, because the current treatments still cannot revive degenerated retinal cells, the best patient outcome that can be achieved is early detection of the disease and application of the appropriate treatment before too much retinal damage has occurred. The opportunities and challenges offered by the new treatment options and disease detection methods have redefined the role of primary care optometrists in AMD management. This review of literature and practice guidelines demonstrates that, in addition to the traditional roles of refraction and visual rehabilitation, the unique position of optometrists as the first-line eye-care providers has allowed them to play an important role in the early detection of AMD, patient education, lifestyle-change counseling, disease monitoring and referral, and nutrition supplement counseling. The active participation of primary care optometrists in the shared care of AMD management is likely to result in great improvement in patient outcomes. Optometrists also need to improve their competence in these areas to meet the new challenges. Although primary care optometrists have always managed patients with AMD, their role in managing this sight-threatening disease has not been adequately documented. In light of the recent game-changing developments in AMD treatment, it is important to review what primary care optometrists are doing, what they can do, and what they should do to improve patient outcomes in the new era of AMD management.Keywords: detection, patient education, lifestyle-change counseling, disease monitoring, disease referral, nutrition supplement counseling