NICE has made the following recommendations about the use of photodynamic therapy (PDT) to treat age-related macular degeneration (ARMD).
NICE recommends PDT for people with wet ARMD who have a confirmed diagnosis of classic subfoveal choroidal neovascularisation (CNV), with no sign of occult CNV. People should also have at least 6/60 vision – this means that they can see (with glasses if they usually wear them) the same line of test letters 6 metres away that a person with normal vision can see when 60 metres away.
PDT treatment should be carried out by doctors who specialise in treating disorders of the retina and who have experience in using PDT.
PDT is not recommended for people who have wet ARMD with mostly classic subfoveal CNV (that is, at least half is classic but there is also some occult CNV). The exception is where the person is treated as part of a clinical study designed to provide useful information on the effectiveness of the treatment.
NICE has not made any recommendations about PDT for people who have ARMD with occult CNV. This is because, when the appraisal process started, the light-sensitive substance was not licensed to be marketed or prescribed for occult CNV in the UK. (This is because its 'marketing authorisation', which is normally needed before a medicine can be marketed or prescribed, did not cover patients with occult CNV. The process of giving a medicine its marketing authorisation is not related to the NICE appraisal process and it is not carried out by NICE. Further information on this is available from the Medicines and Healthcare products Regulatory Agency (MHRA).
Everyone with ARMD who started a course of PDT on the NHS before the NICE guidance was issued should have the option of continuing the course until their clinical condition indicates that it is appropriate to stop. This may be judged by the effects of PDT on the results of fluorescein angiography and the rate of loss of vision.
Additional funding information for this guidance can be found on the Department of Health website.
The recommendations in this guidance represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take this guidance fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this guidance is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the guidance to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.