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RANZCO updates AMD referral pathway for optometrists

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Professor Robyn Guymer has led an expert panel to update RANZCO’s Referral Pathway for Age-Related Macular Degeneration (AMD) Management, which accounts for greater accessibility to retinal imaging equipment and reminds clinicians to be aware of nearby clinical trials.

Guymer, head of macula research at the Centre for Eye Research Australia, was asked by RANZCO to write the first AMD referral pathway for optometrists and other primary health professionals in 2016.

In April 2019, the college formed a working group led by Guymer comprising five retinal specialists to revise the original document. It sought input from various other stakeholders and took more than 12 months to complete before receiving RANZCO Board approval this month.

According to RANZCO, the revised pathway is fit-for-purpose in a new era of more personalised, community-based monitoring where increased availability of retinal imaging instruments allows for greater recognition of retinal pathology and the risk of progressive vision loss.

Using the pathway will also ensure communication between eyecare professionals is consistent so that AMD patients receive correct management at the right time.

“The two main aspects that I was very pleased to see included or reinforced in the revision was the encouragement to use OCT imaging if AMD is present to allow the clinician to gain a much greater understanding of the individual’s disease and risk of further progression to vision loss,” Guymer said.

“With the major increase in our ability to identify OCT-based anatomical changes that are considered risk factors in AMD, the pathway encourages clinicians to perform OCT, if available, when AMD is clinically identified or suspected, to gain this greater appreciation of an individual’s disease and, as such, better target the counselling and the review.”

Guymer said the updated document also isn’t as cluttered, with an improved design layout and fewer words. The working group added a note for eyecare professionals to be aware of clinical trials in AMD in their region.

“This is so that they can refer appropriate and interested people to these trials to help progress the treatment for this disease,” she said.

“I encourage optometrists who see AMD cases to look at, read and try to follow the new guidelines as closely as they can, taking individual practise circumstances into consideration. In particular, simply having us all use the same nomenclature (Beckman classification) when talking about AMD would be a major step forward.”

RANZCO’s inaugural AMD management referral pathway was launched at its 48th scientific congress in 2016, alongside new guidelines for diabetic retinopathy. Earlier that year, the college also introduced a referral pathway for glaucoma management.

The updated AMD referral pathway can be found here.

More reading: RANZCO launches new referral pathways at congress