Early detection and management of macular degeneration—the leading cause of blindness in older Americans—is a tremendous opportunity for optometry, and is becoming a huge advantage for our patients.  Consider:

- Age-related macular degeneration is the leading cause of blindness in Americans over age 65. Approximately 1.75 million Americans age 40 or older have geographic atrophy or neovascular AMD. Due to the rapid aging of the population, this number will increase to almost three million by 2020.1

- More than seven million Americans have drusen measuring 125μm or larger, which is suggestive of AMD.1

- AMD causes approximately 46% of cases of severe visual loss (visual acuity 20/200 or worse) in Americans older than 40.2

- The prevalence, incidence and progression of AMD increases with age. In the Beaver Dam Eye Study (a mostly white population), the prevalence of any AMD was less than 10% in people aged 43 to 54, but it more than tripled among those aged 75 to 85.3

- Direct medical costs related to AMD treatment were estimated at $575 million for 2006.4 That amount is projected to increase to $845 million during the next 15 years due to the growth in the aging population.

In short, AMD is prevalent and has significant effects on patients and the health care system.

We’re the Vital Link
What does this mean for optometry? Because optometrists are the primary contact for eye care for most Americans, we likely play the most important role in the entire chain of care. With the shift of technology, more sophisticated diagnostic equipment and genetic lab tests to order, macular degeneration has become one of the primary disease states requiring regular care and procedures in your practice for the lifetime of the patient. In my opinion, the early diagnosis and management of macular degeneration, from an economic perspective, is to optometry today what refractive surgery was to ophthalmology in years past. Yes, it’s that big—to patients, the health care system at large, and our practices.

While retina surgery is outside of our scope of licensure, the early detection and management of macular degeneration is well within our boundaries. New tools and technology make this advance not only vitally important to our aging patients, but easy to assimilate, integrate and implement in our daily practice routines.

Essentials for Your AMD (and Other) Patients’ Medical Records
1. Establish medical necessity for everything that you do––whether it’s a return office visit, a special ophthalmic test or an Rx for a nutraceutical product or prescription lenses.

2. Code your visit properly by making sure that the level of the visit billed is commensurate with the patient presentation. Don’t code the visit by pattern or diagnosis. Each patient must be recorded as an individual despite having a routine diagnosis.

3. Be aware of Correct Coding Initiative edits as many rules have changed or been modified, which may allow you greater freedom in performing combinations of procedures on the same day when ordered.

4. Take advantage of technology—such as the AMD iManager (ECRVault) patient management software, genetic testing with Macula Risk (ArcticDx) or new OCT technologies—to provide the highest level of care for your patients.

5. Be proactive by recommending and prescribing proper external protection with new lens technologies, and internal protection with nutraceutical supplements.

Optometrists are the primary eye care providers in the US today. Let’s make sure that we’re fulfilling our role in doing our job correctly. Let’s also lead by example; detect, manage and prevent the primary cause of blindness in the world today.

1. Friedman DS, O’Colmain BJ, Muñoz B, et al; Eye Diseases Prevalence Research Group. Prevalence of age-related macular degeneration in the United States. Arch Ophthalmol. 2004 Apr;122(4):564-72.
2. Congdon N, O’Colmain B, Klaver CC, et al; Eye Diseases Prevalence Research Group. Causes and prevalence of visual impairment among adults in the United States. Arch Ophthalmol. 2004 Apr;122(4):477-85.
3. Klein R, Klein BE, Linton KL. Prevalence of age-related maculopathy. The Beaver Dam Eye Study. Ophthalmology. 1992 Jun;99(6):933-43.
4. Rein DB, Zhang P, Wirth KE, et al. The economic burden of major adult visual disorders in the United States. Arch Ophthalmol. 2006 Dec;124(12):1754-60.