People with suspected late AMD (wet active) should be referred to a macula service within one working day, NICE has said in new guidance.

According to the Macular Society, over 600,000 people in the UK are affected by age-related macular degeneration (AMD).

The new NICE guideline aims to ensure these people, who are at risk of blindness, receive a prompt diagnosis and fast access to effective treatments.

AMD is the term given to ageing changes that occur in the central area of the retina (macula) that affect a person’s ability to perform daily activities such as driving, reading and recognising faces.

Late AMD (wet active) is the most damaging form and can lead to a rapid worsening of vision.

The guideline recommends that people with late AMD (wet active) are offered anti-vascular endothelial growth factor (anti-VEGF) drugs, within 14 days of referral to the macula service. These drugs are injected into the eye and prevent the abnormal growth of blood vessels which cause the deterioration in sight.

Professor Mark Baker, Director of the Centre for Guidelines at NICE, said: “AMD can be a life changing condition for people if it is not identified early on. There are around 26,000 new cases of wet AMD in the UK each year and if left untreated over half will become visually impaired or blind within 3 years. Therefore the need to provide timely diagnosis and treatment is important.”

In all cases the recommendations for anti-VEGF treatment are for people with a visual acuity score between 6/12 and 6/96. Although the guideline does identify that treatment in eyes with a visual acuity better than 6/12 is clinically effective and may be cost effective depending on the regimen used.

In eyes with visual acuity worse than this, the guideline recommends that anti-VEGF treatment should also be considered if it’s expected to improve the person's overall vision (for example, if the affected eye is the person’s better-seeing eye).

The guideline also includes recommendations on non-drug strategies to manage AMD. This includes group-based rehabilitation programmes and referring people to low-vision services.
NHS organisations should compare their current practice with these recommendations and consider what changes may need to be made to put them into practice. In considering any changes, they will need to take into account any extra costs and savings involved. The speed at which these recommendations are adopted by local NHS services will depend on the resources they have available and the other priorities they are dealing with.