Why Get Tested
The consequences of untreated neovascular AMD is blindness. Studies show that patients presenting to retinal specialists with vision loss associated with neovascular disease have a poor outcome, with only 50% achieving a meaningful improvement in vision. In contrast, those that present prior to vision loss do much better, with 80% having sustained functional vision. Unfortunately, over 80% of patients are seen too late and the functional improvement after treatment of the affected eye is minimal. The identification of individuals at risk is the responsibility of primary eye care professionals, a group that cares for and manages the vast majority of patients with visual problems.
The Macula Risk genetic test incorporates all the known genetic predictors of AMD progression and is a powerful way of identifying which individuals who present with drusen will progress to neovascularization. The test stratifies individuals into 5 risk groups as follows:
Those individuals with a Macula Risk score of 1 (MR1) are predicted to have a below average risk of progressing, while those with a MR5 score have over 70% risk of progressive disease. About 20% of the population is predicted to have an elevated risk of AMD progression, as shown by the red bars.
In conjunction with a team of retinal specialists, a co-management protocol for patients with dry AMD presenting to a primary eye care professional has been developed. The emphasis is on appropriate schedules of surveillance by an optometrist or general ophthalmologist with ultimate timely referral to a dedicated retinal specialist when specific intervention is required. This approach utilizes the broad network of community based primary eye doctors and targeted referrals creating a cost effective community-based system of care.
We recommend Macula Risk testing for the following patients, based on presenting AREDS AMD score:
Genetic testing is recommended for all patients except those with AREDS stage 1 disease, who are under 50 years of age and who do not have a family history of AMD. Management of patients after genetic testing is at the discretion of the ordering doctor but we recommend the following protocol:
Primary Eye Care Management: Patient Stratification by Macula Risk Score, AREDS Stage, and Age
The intensity of monitoring varies according to the genetic risk of the individual. For those over 60 years of age with AREDS 3 AMD and a low genetic risk score (MR1), the recommended follow-up frequency is every 8-12 months. For this same group at high genetic risk (MR5), optometric review should occur every 4-6 months with regular fundal photographs, OCT scans, home PHP and review by a retinal specialist. It is estimated that 20% patients will need to be enrolled into a program of enhanced care. This protocol emphasizes the importance of optometry and general ophthalmology in primary care and monitoring and details a program of concurrent care with community based retinal specialists.
Office-based continuing education and administrative support is available for all members and can be coordinated through the American Optometric Association offices at 1 (800) 365-2219.