Synopsis
Distinguish age-related macular changes from active neovascular disease, recognise a meaningful change in central vision and connect rapid referral with treatment and visual support.
- AMD primarily affects central vision used for reading and recognising faces; peripheral vision may remain useful.
- Drusen and pigment change establish a risk context, while fluid, haemorrhage and new symptoms raise concern for active neovascularisation.
- Examine and test each eye separately, because a better fellow eye can conceal unilateral deterioration.
Key red flags
New metamorphopsia, central scotoma or macular haemorrhage warrants urgent assessment for active wet AMD rather than routine follow-up for an old dry-AMD diagnosis.
Investigation priorities
Document the change in central visual function and its effect on daily activities.
Management branches
New central symptoms or examination findings raise suspicion of neovascular AMD.
- Refer directly to the macula service through the urgent route, normally within one working day, even if visual impairment is not yet reported.
- Include onset, each eye's acuity, prior AMD and treatment history, examination findings and available OCT without delaying the referral to obtain extra images.
Key medicines
Bevacizumab gamma, Lytenava 25 mg/mLFor adult neovascular AMD, administer 1.25 mg in 0.05 mL by intravitreal injection every four weeks initially. Continue monthly until maximum acuity and/or no disease activity; three or more consecutive monthly injections may be needed. Thereafter individualise intervals using visual and anatomical activity. Discontinue if continued treatment gives no benefit and withhold for the product's specified safety triggers.