Current evidence-based treatment options for patients with wet age-related macular degeneration in primary care include intravitreal anti-VEGF therapy, such as ranibizumab, aflibercept, and bevacizumab, which are recommended for late AMD (wet active) with specific visual acuity criteria NICE NG82.
Ranibizumab is recommended if the patient's best-corrected visual acuity is between 6/12 and 6/96, with no permanent structural damage to the central fovea, lesion size less than or equal to 12 disc areas, and evidence of recent disease progression NICE NG82.
Aflibercept is also recommended, used in accordance with the guidelines for ranibizumab, and provided under a patient access scheme with manufacturer support NICE NG82.
Bevacizumab, although unlicensed in the UK for this indication, is considered by the guideline committee to have equivalent effectiveness and safety, and may be used following professional guidance and informed consent NICE NG82.
In addition, photodynamic therapy (PDT) with verteporfin may be used as a second-line treatment in combination with anti-VEGF therapy, but photodynamic therapy alone is not recommended NICE CKS,NICE CKS,NICE NG82.