Age-Related Macular Degeneration Grading

Age-Related Macular Degeneration (ARMD) is a primary cause of central vision loss in older adults. Accurate grading of ARMD severity guides clinical decisions, determines appropriate monitoring schedules, and directs timely therapeutic interventions. Structured grading systems enable optometrists and ophthalmologists to consistently identify early disease stages, monitor progression, and implement targeted management plans to preserve visual function.

Clear ARMD classification supports standardized care, effective communication among eye care providers, and enhances patient education regarding their condition and prognosis.

Clinicians classify ARMD into stages based on specific retinal findings, including drusen size, pigmentary changes, geographic atrophy, and neovascularization:

• Early ARMD: Small drusen (less than 63 µm) and minimal pigment changes. Typically asymptomatic, with stable visual acuity.
• Intermediate ARMD: Medium to large drusen (≥125 µm) and noticeable pigmentary abnormalities. Patients may experience mild vision impairment, especially in low-light conditions.
• Advanced ARMD: Divided into geographic atrophy (non-neovascular), characterized by significant retinal thinning, and neovascular ARMD, marked by abnormal blood vessels (choroidal neovascularization) causing rapid central vision deterioration.

Effective ARMD assessment requires comprehensive imaging and clinical evaluations:

• Fundus Examination: Visual inspection identifies drusen characteristics and pigmentary changes essential for initial grading.
• Optical Coherence Tomography (OCT): High-resolution imaging detects subtle retinal layer changes, including fluid accumulation or early geographic atrophy.
• Fundus Autofluorescence (FAF): Reveals areas of retinal pigment epithelial (RPE) disruption and atrophy, critical in assessing disease progression.
• Fluorescein Angiography (FA): Identifies choroidal neovascular membranes and active leakage, essential for managing advanced neovascular ARMD.

ARMD staging directly informs clinical decision-making, follow-up frequency, treatment strategies, and patient counseling:

• Early ARMD: Recommend lifestyle interventions (smoking cessation, dietary changes, UV protection) and monitor every 6–12 months.
• Intermediate ARMD: Initiate AREDS-2 supplements, monitor closely every 4–6 months, and counsel on recognizing progression symptoms.
• Advanced ARMD (Geographic Atrophy): Schedule frequent evaluations every 4–6 months, recommend low vision rehabilitation, and support visual function with adaptive strategies.
• Advanced ARMD (Neovascular): Refer urgently for anti-VEGF therapy, establish monthly OCT monitoring initially, and closely coordinate care with retinal specialists.