Original Title: Fotodynamisk behandling af karnydannelse bag øjets nethinde - en medicinsk teknologivurdering

Authors' objectives: Age-related macular degeneration (AMD) is the leading cause of visual impairment and blindness in Denmark and other industrialized countries. The most prominent cause of severe visual loss in these patients is the development of subretinal new vessels of choroidal origin (CNV) secondary to degenerative changes in the retinal pigment epithelium and the underlying Bruchs membrane. This report assesses the effectiveness of photodynamic treatment of CNV in AMD.

Authors' recommendations: Photodynamic treatment of CNV in AMD is being proposed primarily for a subgroup of patients with predominantly classic CNV, i.e. new vessels with angiographic characteristics indicating that the vessels are found in front of the retinal pigment epitelium. Controlled trials demonstrate that few patients will experience an improvement in visual acuity during the course of treatment, but a significant reduction in the rate of visual loss has been documented over a period of observation of 2 years. Consequently, the treatment may offer a better chance for the patient to preserve daily living skills, to be able to use low-vision aids, and other functions associated with a high living standard. Results from the most recent clinical trials document a beneficial effect of photodynamic therapy for subfoveal CNV in diseases other than AMD. This may have a positive influence on the cost-effectiveness because the patients with these conditions are younger and have a longer life expectancy. The assessment indicates that photodynamic therapy for CNV secondary to AMD should be continued where it has already been established as a therapeutic modality, and that this new treatment should be made equally available throughout Denmark by promoting dynamic collaboration between primary care ophthalmologists and secondary ophthalmological referral centers. Proper diagnosis and administration of therapy is critically dependent on subspecialty skills, experience, and volume, but the necessary equipment is widely available or can be installed at low cost. The critical medical task is to distinguish treatable from untreatable conditions. The new treatment is mechanistically akin to photocoagulation and it is likely to gradually be incorporated into the general spectrum of therapeutic modalities, but it will remain a task for the subspecialized ophthalmologist.

Authors' methods: Systematic review

Project Status: Completed

Year Published: 2002

URL for published report: https://www.sst.dk/da/Udgivelser/2002/Fotodynamisk-behandling-af-karnydannelse-bag-oejets-nethinde---en-medicinsk-teknologivurdering

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Denmark

Organisation Name: Danish Centre for Evaluation and Health Technology Assessment

Contact Address: National Board of Health, PO Box 1881, Islands Brygge 67, DK-2300 Copenhagen S, Denmark. Tel: 45 72 22 74 48; Fax: 45 72 22 74 07/67

Contact Name: dacehta@sst.dk

Contact Email: dacehta@sst.dk

Copyright: Danish Centre for Evaluation and Health Technology Assessment (DACEHTA) (formerly DIHTA)