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Macular Degeneration F051

Document
Last amended 
14 July 2016
Current RMA Instruments:
Consolidated RH SOP
13 of 2009 as amended by 47 of 2012 and 68 of 2012
Balance of Probabilities SOP
14 of 2009
Changes from previous Instruments:

SOP Bulletin 134

ICD Coding:
  • ICD-9-CM Codes: 362.50-362.52
  • ICD-10-AM Codes: H35.3

Brief description

The macula is a small area near the centre of the retina that is responsible for the sharp, central, colour vision that is possible in good light.  (Age-related) macular degeneration (AMD) causes loss of this vision in elderly subjects and is the leading cause of blindness in Australia.  A range of different terminologies may be used to describe the condition and this can be confusing.  See details below and seek medical advice if in doubt.

Confirming the diagnosis

Macular degneration is a clinical diagnosis based upon the presence of characteristic findings on dilated eye examination using a slit lamp.  Further testing may be undertaken to fully investigate the condition, including fluorescein dye retinal angiography and optical coherence tomography.

The SOP has factors that aply only to late age-related macular degeneration (geographic atrophy or choroidal neovascularisation).  Information on the type and stage of the disease should be available from a specialist's report.

The relevant medical specialist is an ophthalmologist.

Additional diagnoses covered by SOP (also see comments below)
  • age-related macular degeneration (late or early)
  • choroidal neovascularisation
  • dry, wet, nonexudative or neovascular macular degeneration
  • geographic atrophy
  • senile macular degeneration
  • age-related maculopathy
Conditions not covered by SOP
  • cystoid macular oedema# ICD code 362.53
  • degeneration of the optic disc# ICD code 377.21 to 377.24
  • diabetic maculopathy#, propagates to diabetes mellitus SOP
  • drusen (see comments), ICD code 362.57, 362.77 or 377.21
  • hereditary retinal dystrophies# ICD code 362.70 to 362.77
  • macular cyst, hole or pseudohole# ICD code 362.54
  • peripheral retinal degeneration# ICD code 362.60 to 362.66
  • toxic maculopathy# ICD code 362.55

# non-SOP condition

Clinical onset

Early disease may be asymptomatic.  Geographic atrophy (dry AMD) usually presents with gradual loss of vision in one or both eyes.  Choroidal neovascularization (wet AMD) usually appears in one eye first and presents with acute visual distortion or loss of central vision.  Once the diagnosis has been confirmed, it may be possible to back-date clinical onset to when central visual loss first developed, although other causes of loss of vision would need to be ruled out.

Clinical worsening

Dry AMD typically progresses slowly over years and there is no proven effective treatment.  Wet AMD progresses more rapidly.  Effective drug treatments and other therapies are available.  Clinical worsening beyond the normal course of the disease will be difficult to establish and will require specialist ophthalmological opinion.

Further comments on diagnosis

Drusen are tiny yellow or white accumulations of extracellular material that can build up under the macula of the eye.  Drusen are found in both normal ageing eyes and in age-related macular degeneration.  There are various types of drusen that are of differing significance.  Increased or decreased retinal pigment may also be seen in macular degeneration.  Note the following classification (other classifications based of soft drusen size may also be used to define early age-related macular degeneration):

Macula examination findings

 

Significance

Hard drusen only

=

Normal ageing eyes

Soft distinct drusen only, or

Pigmentary abnormalities only

=

At risk for age-related macular degeneration (no disease present)

Soft, indistinct or reticular drusen (only), or

Soft drusen (distinct, indistinct or reticular) with pigmentary abnormalities

=

Early age-related macular degeneration

Geographic atrophy, or

Neovascularisation

=

Late age-related macular degeneration