Nonpharmacologic Therapy

Non-neovascular AMD

Advise patients to stop smoking as observational data support a causal relationship

between smoking and AMD.

Drusen ablation by laser has been used in non-neovascular AMD. However, it is not clear if the treatment reduces progression to neovascular AMD. There is a pos-

sibility that the treatments may induce neovascularization and retinal atrophy. Other nonpharmacologic therapies are in trials but there is insufficient evidence for experts

to recommend these procedures at this time. Neovascular AMD

Thermal laser photocoagulation reduces severe visual loss 2 to 5 years after the procedure, but leads to an immediate and permanent reduction in central vision. There is

a 50% chance that leakage will recur in the next 2 years after the procedure.

Photodynamic therapy uses nonthermal red light to activate verteporfin, which pro-

duces reactive oxygen species that locally damage the neovascular endothelium. Verteporfin treatment reduces the risk of loss of visual acuity and legal blindness over 1 to 2 years. Long-term results are not yet available. Severe photosensitivity for 3 to 5 days after the procedure is common and some patients experience a severe loss of vision. Eventually, most patients have some visual recovery. This procedure requires multiple treatments over time.25 Other nonpharmacologic therapies are in trials but there is insufficient evidence for experts to recommend these procedures at this

time.22

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