Referral criteria from primary care - age related macular degeneration (AMD)

Referral criteria have been outlined by NICE (1):

Early AMD

• confirm a diagnosis of early AMD using slit-lamp biomicroscopic fundus examination alone
• people with asymptomatic early AMD should not be referred to hospital eye services for further diagnostic tests

Late AMD (dry)

• confirm a diagnosis of late AMD (dry) using slit-lamp biomicroscopic fundus examination
  
  
• refer people with late AMD (dry) to hospital eye services only:
  • for certification of sight impairment or if this is how people access low-vision services in the local pathway
  • or if they develop new visual symptoms that may suggest late AMD (wet active) or
  • if it would help them to participate in research into new treatments for late AMD (dry)

Late AMD (wet active)

• make an urgent referral for people with suspected late AMD (wet active) to a macula service, whether or not they report any visual impairment. The referral should normally be made within 1 working day but does not need emergency referral
• optical coherence tomography (OCT) should be offered to people with suspected late AMD (wet active)
• fundus fluorescein angiography (FFA) should not be offered to people with suspected late AMD (wet active) if clinical examination and OCT exclude neovascularisation
• offer FFA to people with suspected late AMD (wet active) to confirm the diagnosis if OCT does not exclude neovascular disease.For eyes with confirmed late AMD (wet active) for which antiangiogenic treatment is recommended, offer treatment as soon as possible (within 14 days of referral to the macula service)

Reference:

• NICE (January 2018). Age-related macular degeneration