Practice Location Selection:
Select a Practice
Configuration
Step 1:
  
Patient Assessment
Does your patient have
Wet AMD
?
Yes
No
Does your patient have
geographic atrophy
?
Yes
No
Is the geographic atrophy
subfoveal
?
Yes
No
Does the patient have
drusen in the left eye
?
Select
No
<63μm
63-125μm
≥125μm
Does the patient have
drusen in the right eye
?
Select
No
<63μm
63-125μm
≥125μm
Does your patient
pigmentary changes
in either eye?
Select
Left Eye
Right Eye
Both
Neither
Does your patient have
normal dark adaptation curve
?
Yes
No
Type of
pigment changes
?
Mild
Clumping
Patient's AMD severity is
Subclinical
Subclinical
Early
Moderate
Advanced
Risk of developing Advanced AMD:
Next
5 Years
Next
10 Years
0%
0%
LOW RISK
Change suggested supplement:
MacuHealth
✖ Reset All
Next
Based on the above information the following is a suggested
patient care follow-up plan
Supplement
MacuHealth
Follow-Up
Every 6 months
Fundus Photos
Annually
OCT
As Indicated
Dark Adaptation
Until RI > 20 minutes
FAF
As Indicated
MPOD
No
Genetic Testing
At Dx
Color Contrast Threshold
None
Contrast
None
ForeseeHome
No
Amsler Grid
+/-
Please refer to a specialist
Normal Aging, No AMD
Step 2:
  
Patient Overview
Diagnosis
Patient's AMD severity is
Subclinical
Risk of developing Advanced AMD:
Next
5 Years
Next
10 Years
0%
0%
LOW RISK
Next Steps
Based upon the evidence, your doctor has prescribed
None
 
Supplement
Based upon the evidence and your risk for progression,
your doctor will monitor you
 
Every 6 months
If you have trouble reading, driving or recognizing faces this may be a sign that AMD has progressed.
Please call our office immediately if vision changes occur.
Learn More
What is Age-related Macular Degeneration (AMD)?
The leading cause of vision loss in people 50+ years
Vision loss often occurs gradually over time
Poor night vision is an early symptom
Types of AMD
There are two types of AMD:
 
Dry AMD
 
(more common) and
 
Wet AMD
 
(usually more severe). Most AMD starts as dry and in 10 - 20% of individuals can progress to wet.
Wet AMD leads to bleeding and swelling in the back of the eye, this is treated with injections.
Treatment
Unfortunately, there is no cure for AMD. Age and family history are the most important risk factors. However, there are several things that can be done to reduce the risk of progression and vision loss.
Don't smoke
Eat healthy food as fruits and vegetables
Increase your Omega-3 fatty acids
Exercise regularly
Wear sunglasses that blocks UV light
Take vitamins help reduce the risk of AMD progression
< Back
Print
New Assessment
AMD Eye Examination Report
Patient
Name:
DOB:
/
/
Address:
Phone:
Family / General Practice Physician
Name:
Address:
Phone:
Fax:
Other Coordinating Physician
Name:
Address:
Phone:
Fax:
This patient received an eye examination on
with the following results.
Diagnosis
Patient's AMD severity is
Subclinical
Risk of developing Advanced AMD:
Next
5 Years
Next
10 Years
0%
0%
LOW RISK
Next Steps
Based upon the evidence, I have prescribed
MacuHealth
 
Supplement
Based upon the evidence and the patients risk for progression,
I will monitor the patient
 
Every 6 months
Dilated Fundus Evaluation:
Perfomed
Pt Declined
Contraindicated - Reason:
Testing to monitor for progression will include:
Fundus Autofluorescence (FAF)
Optical Coherence Tomography (OCT)
AdaptDx
Genetic Testing
I have discussed the following things that can be done to reduce the risk of progression and vision loss:
Don't smoke
Eat healthy food as fruits and vegetables
Increase your Omega-3 fatty acids
Exercise regularly
Wear sunglasses that blocks UV light
Take vitamins help reduce the risk of AMD progression
Comments:
Next appt date
(if avail)
:
/
/
Signature:
/
/
Loading...
{{OfficeName}}
Dr. {{DoctorName}}
{{Supplement}}