title: The predictive value of subjective symptoms and clinical signs for the presence of treatment-requiring exudative age-related macular degeneration.
abstract: OBJECTIVE
  The introduction of vascular endothelial growth factor inhibitors for the treatment of exudative age-related macular degeneration (AMD) has increased the referral rates of AMD patients with visual symptoms to treating centres considerably. However, a large proportion of the referred patients do not qualify for treatment implying that considerable resources could be saved if these patients could be identified on the basis of the clinical data available in the referring nonspecialized setting.
  
  
  METHODS
  A prospective observational study of 1682 consecutive patients referred with suspicion of exudative AMD qualifying for intravitreal angiostatic treatment. On the basis of the structured interviewing about symptoms, ophthalmoscopy, optical coherence tomography scanning, and fluorescein angiography, the patients were divided into two groups: one qualifying for and another not qualifying for treatment. Multiple logistic regression was used to identify independent parameters predicting the need for treatment.
  
  
  RESULTS
  The presence of metamorphopsia, dyschromatopsia, retinal haemorrhages and exudates, central retinal thickness, and the absence of micropsia were highly significant individual determinants of treatment-requiring AMD. Sudden onset and worsening of symptoms and the presence of a central dark spot covaried with the occurrence of retinal haemorrhages, whereas reduced visual acuity and blurred vision covaried with the presence of both haemorrhages and exudates.
  
  
  CONCLUSIONS
  Patients with treatment-requiring AMD can be reliably identified by questioning about the presence of metamorphopsia and dyschromatopsia and the absence of micropsia, combined with ophthalmoscopical detection of retinal haemorrhages and exudates. This information may improve the triage of patients considered for referral.
authors.affiliation: Department of Ophthalmology, Århus University Hospital, Århus C, Denmark.
authors.forename: Anders
authors.initials: A
authors.lastname: Hessellund
authors.forename: Dorte Ancher
authors.initials: DA
authors.lastname: Larsen
authors.forename: Toke
authors.initials: T
authors.lastname: Bek
mesh_terms: D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D003941:Diagnostic Techniques, Ophthalmological; D005122:Exudates and Transudates; D005451:Fluorescein Angiography; D006801:Humans; D058449:Intravitreal Injections; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012166:Retinal Hemorrhage / Q000175:diagnosis; D012307:Risk Factors; D012720:Severity of Illness Index; D041623:Tomography, Optical Coherence; D014218:Triage; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014786:Vision Disorders / Q000175:diagnosis* / Q000188:drug therapy; D014792:Visual Acuity / Q000502:physiology; D057135:Wet Macular Degeneration / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D020533:Angiogenesis Inhibitors; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A