Full macular translocation66. Eandi CM, Giansanti F, Virgili G. Macular translocation for neovascular age‐related macular degeneration. Cochrane Database Syst Rev. 2008;(4):CD006928. PMID: 18843739; doi: 10.1002/14651858.CD006928.pub2. https://doi.org/10.1002/14651858.CD00692...
|
|
Full macular translocation versus PDT |
Benefit of macular translocation:
• Gain of three or more lines in the ETDRS test
• Change of visual acuity
• Change of near visual acuity score
No difference between interventions groups:
• Progression to loss of vision
• Change of contrast sensitivity
• Recurrence of choroidal neovascularization
Benefit of PDT:
|
NA |
Submacular surgery77. Giansanti F, Eandi CM, Virgili G. Submacular surgery for choroidal neovascularisation secondary to age‐related macular degeneration. Cochrane Database Syst Rev. 2009;(2):CD006931. PMID: 19370663; doi: 10.1002/14651858.CD006931.pub2. https://doi.org/10.1002/14651858.CD00693...
|
|
Submacular surgery versus observation |
No difference between groups: Benefit of observation:
|
|
Steroid implantation (intra‐ and peri‐ocular)88. Geltzer A, Turalba A, Vedula SS. Surgical implantation of steroids with antiangiogenic characteristics for treating neovascular age‐related macular degeneration. Cochrane Database Syst Rev. 2013;(1):CD005022. PMID: 23440797; doi: 10.1002/14651858.CD005022.pub3. https://doi.org/10.1002/14651858.CD00502...
|
|
Anecortave acetate versus placebo |
• Progression to loss of vision: benefit over placebo for anecortave 15 mg**, but not for 3 mg or for 30 mg |
NA |
Triamcinolone acetonide versus placebo |
• Progression to loss of vision: no difference between groups |
NA |
Anecortave acetate versus PDT |
|
NA |
Laser/photo/radiotherapy |
Intervention |
Participants |
Comparisons |
Main findings |
Certainty of evidence (GRADE)* |
Laser photocoagulation |
-
AMD with drusen
-
(n = 2,159/3,580 eyes)99. Virgili G, Michelessi M, Parodi MB, Bacherini D, Evans JR. Laser treatment of drusen to prevent progression to advanced age‐related macular degeneration. Cochrane Database Syst Rev. 2015;(10):CD006537. PMID: 26493180; doi: 10.1002/14651858.CD006537.pub3. https://doi.org/10.1002/14651858.CD00653...
|
Laser versus no intervention |
Benefit of laser:
• Reduction of drusen
• Risk of choroidal neovascularization
• Risk of geographic atrophy
• Progression to loss of vision
|
|
-
AMD
-
(n = 2,064)1010. Virgili G, Bini A. Laser photocoagulation for neovascular age‐related macular degeneration. Cochrane Database Syst Rev. 2007;(3):CD004763. PMID: 17636773; doi: 10.1002/14651858.CD004763.pub2. https://doi.org/10.1002/14651858.CD00476...
|
Direct photocoagulation of the entire choroidal neovascularization versus no intervention |
Benefit of photocoagulation: Benefit of no intervention:
|
NA |
Perifoveal photocoagulation versus observation |
Benefit of photocoagulation:
|
NA |
PDT1111. Wormald R, Evans J, Smeeth L, Henshaw K. Photodynamic therapy for neovascular age‐related macular degeneration. Cochrane Database Syst Rev. 2007;(3):CD002030. PMID: 17636693; doi: 10.1002/14651858.CD002030.pub3. https://doi.org/10.1002/14651858.CD00203...
|
|
PDT with verteporfin versus PDT with 5% dextrose in water |
-
Benefit of PDT/verteporfin
-
• Progression to loss of vision
-
Time point for measurement: 12 and 24 months
-
No difference between groups:
-
• Risk of severe decrease in visual acuity
-
Time point for measurement: one week
-
Benefit of PDT/dextrose:
-
Infusion-related back pain: higher with PDT/verteporfin (RR 9.93; 95% CI 2.82 to 35.02; 4 RCTs; 1439 participants; high certainty of evidence)
-
Time point for measurement: one week
|
|
Radiotherapy1212. Evans JR, Sivagnanavel V, Chong V. Radiotherapy for neovascular age‐related macular degeneration. Cochrane Database Syst Rev. 2010;(5):CD004004. PMID: 20464726; doi: 10.1002/14651858.CD004004.pub3. https://doi.org/10.1002/14651858.CD00400...
|
|
External beam radiotherapy or plaque brachytherapy versus no intervention |
-
Benefit of radiotherapy:
-
• Progression of loss of vision at 24 months (only considering loss of six or more lines)
-
No difference between groups:
-
• Progression of loss of vision at 24 months
|
|
Intravitreal injections of anti-VEGF |
Intervention |
Participants |
Comparisons |
Main findings |
Certainty of evidence (GRADE)* |
Aflibercept1313. Sarwar S, Clearfield E, Soliman MK, et al. Aflibercept for neovascular age‐related macular degeneration. Cochrane Database Syst Rev. 2016;(2):CD011346. PMID: 26857947; doi: 10.1002/14651858.CD011346.pub2. https://doi.org/10.1002/14651858.CD01134...
|
|
Aflibercept versus no intervention |
-
No difference between groups:
-
• Change in best‐corrected visual acuity (BCVA)
-
• Gain of 15 or more letters of BCVA
-
• Loss of 15 or more letters of BCVA
-
• Serious systemic adverse events
-
Time points for measurement: 12 and 24 months
|
|
Bevacizumab ***1414. Solomon SD, Lindsley K, Vedula SS, Krzystolik MG, Hawkins BS. Anti‐vascular endothelial growth factor for neovascular age‐related macular degeneration. Cochrane Database Syst Rev. 2014;(8):CD005139. PMID: 25170575; doi: 10.1002/14651858.CD005139.pub3. https://doi.org/10.1002/14651858.CD00513...
|
|
Bevacizumab versus standard therapy |
|
|
Ranibizumab***1414. Solomon SD, Lindsley K, Vedula SS, Krzystolik MG, Hawkins BS. Anti‐vascular endothelial growth factor for neovascular age‐related macular degeneration. Cochrane Database Syst Rev. 2014;(8):CD005139. PMID: 25170575; doi: 10.1002/14651858.CD005139.pub3. https://doi.org/10.1002/14651858.CD00513...
|
|
Ranibizumab versus sham |
|
|
Pegaptanib1414. Solomon SD, Lindsley K, Vedula SS, Krzystolik MG, Hawkins BS. Anti‐vascular endothelial growth factor for neovascular age‐related macular degeneration. Cochrane Database Syst Rev. 2014;(8):CD005139. PMID: 25170575; doi: 10.1002/14651858.CD005139.pub3. https://doi.org/10.1002/14651858.CD00513...
|
|
Pegaptanib versus sham |
|
|
Systemic medication |
Intervention |
Population |
Comparisons |
Main findings |
Certainty of evidence (GRADE)* |
Interferon alpha1717. Reddy U, Krzystolik M. Antiangiogenic therapy with interferon alfa for neovascular age‐related macular degeneration. Cochrane Database Syst Rev. 2006;(1):CD005138. PMID: 16437522; doi: 10.1002/14651858.CD005138.pub2. https://doi.org/10.1002/14651858.CD00513...
|
|
Interferon alpha versus placebo |
|
NA |
Statins1818. Gehlbach P, Li T, Hatef E. Statins for age‐related macular degeneration. Cochrane Database Syst Rev. 2016;(8):CD006927. PMID: 27490232; doi: 10.1002/14651858.CD006927.pub5. https://doi.org/10.1002/14651858.CD00692...
|
|
Simvastatin versus placebo |
-
No difference between groups:
-
• Visual acuity at three months of treatment, and at 45 days and 12 months after the completion of treatment
-
• Drusen score at 12 months
-
• Progression of AMD at 36 months
-
• Adverse events
|
|
Phytotherapy/vitamins/supplements |
Intervention |
Population |
Comparisons |
Main findings |
Certainty of evidence (GRADE)* |
Beta-carotene |
-
Healthy individuals
-
(n = 22,083)1919. Evans JR, Lawrenson JG. Antioxidant vitamin and mineral supplements for preventing age‐related macular degeneration. Cochrane Database Syst Rev. 2017;7:CD000253. PMID: 28756617; doi: 10.1002/14651858.CD000253.pub4. https://doi.org/10.1002/14651858.CD00025...
|
Beta-carotene versus placebo |
|
|
Lutein and/or zeaxanthin |
AMD2020. Evans JR, Lawrenson JG. Antioxidant vitamin and mineral supplements for slowing the progression of age‐related macular degeneration. Cochrane Database Syst Rev. 2017;7:CD000254. PMID: 28756618; doi: 10.1002/14651858.CD000254.pub4. https://doi.org/10.1002/14651858.CD00025...
|
Lutein and/or zeaxanthin versus placebo |
-
No difference between groups:
-
• Progression to late AMD
-
• Progression to loss of vision
-
• Quality of life evidence
-
• Mortality
|
-
Low
-
Low
-
Moderate
-
Very low
|
Multivitamins |
-
Healthy men
-
(n = 14,233)1919. Evans JR, Lawrenson JG. Antioxidant vitamin and mineral supplements for preventing age‐related macular degeneration. Cochrane Database Syst Rev. 2017;7:CD000253. PMID: 28756617; doi: 10.1002/14651858.CD000253.pub4. https://doi.org/10.1002/14651858.CD00025...
|
|
-
Harm from multivitamins:
-
• Overall risk of AMD
-
• Risk of skin rashes
|
|
-
AMD
-
(n = 2,445)2020. Evans JR, Lawrenson JG. Antioxidant vitamin and mineral supplements for slowing the progression of age‐related macular degeneration. Cochrane Database Syst Rev. 2017;7:CD000254. PMID: 28756618; doi: 10.1002/14651858.CD000254.pub4. https://doi.org/10.1002/14651858.CD00025...
|
|
-
Benefit of multivitamins:
-
• Progression to late AMD
-
• Progression to loss of vision
-
• Quality of life
-
Harm from multivitamins:
-
• Risk of yellow skin
|
-
Moderate
-
Moderate
-
Very low
-
Very low
|
Omega-3 fatty acids2222. Lawrenson JG, Evans JR. Omega 3 fatty acids for preventing or slowing the progression of age-related macular degeneration. Cochrane Database Syst Rev. 2015;(4):CD010015. PMID: 25856365; doi: 10.1002/14651858.CD010015.pub3. https://doi.org/10.1002/14651858.CD01001...
|
|
|
-
No difference between groups:
-
• Progression to advanced AMD
-
• Progression to loss of vision at 24 and 36 months
-
• Adverse events
|
|
Vitamin C |
-
Healthy men
-
(n = 14,236)1919. Evans JR, Lawrenson JG. Antioxidant vitamin and mineral supplements for preventing age‐related macular degeneration. Cochrane Database Syst Rev. 2017;7:CD000253. PMID: 28756617; doi: 10.1002/14651858.CD000253.pub4. https://doi.org/10.1002/14651858.CD00025...
|
Vitamin C versus placebo |
|
|
Vitamin E |
-
Healthy individuals
-
(n = 55,614)1919. Evans JR, Lawrenson JG. Antioxidant vitamin and mineral supplements for preventing age‐related macular degeneration. Cochrane Database Syst Rev. 2017;7:CD000253. PMID: 28756617; doi: 10.1002/14651858.CD000253.pub4. https://doi.org/10.1002/14651858.CD00025...
|
Vitamin E versus placebo |
|
|
|
Vitamin E versus placebo |
-
No difference between groups:
-
• Progression to late AMD
-
• Progression to loss of vision
-
• Withdrawal due to adverse events
-
No serious adverse events
|
|
Zinc2020. Evans JR, Lawrenson JG. Antioxidant vitamin and mineral supplements for slowing the progression of age‐related macular degeneration. Cochrane Database Syst Rev. 2017;7:CD000254. PMID: 28756618; doi: 10.1002/14651858.CD000254.pub4. https://doi.org/10.1002/14651858.CD00025...
|
|
Zinc versus placebo |
|
|