Professional Statements and Societal Positions Guidelines
National Institute of Health and Excellence – 2018
In 2018, the National Institute for Health and Care Excellence updated its 2003 guidance on the use of photodynamic therapy for age-related macular degeneration. The Institute made the following recommendations:
- Recommends against use of photodynamic therapy as monotherapy for late (wet) age-related macular degeneration and against use of photodynamic therapy as first-line adjunctive therapy to antivascular endothelial growth factor therapies for late (wet) age-related macular degeneration
- Recommends for photodynamic therapy as second-line adjunctive therapy to antivascular endothelial growth factor therapies for late (wet) age-related macular degeneration in a trial setting.
American Academy of Ophthalmology – 2015
A 2015 preferred practice pattern guideline on age-related macular degeneration from the American Academy of Ophthalmology has described verteporfin photodynamic therapy as a treatment option approved by the U.S. Food and Drug Administration for subfoveal lesions and predominantly classic choroidal neovascularization (choroidal neovascularization) related to age-related macular degeneration.
The 2015 update stated that anti-vascular endothelial growth factor therapies have become first-line therapy for treating and stabilizing most cases of age-related macular degeneration. Verteporfin photodynamic therapy is a less commonly used treatment for neovascular age-related macular degeneration; recommendations stated that the following diagnoses are eligible for verteporfin photodynamic therapy:
- “Macular choroidal neovascularization, new or recurrent, where the classic component is >50% of the lesion and the entire lesion is ≤5400 μm in greatest linear diameter
- Occult choroidal neovascularization may be considered for PDT [photodynamic therapy] with vision <20/50 or if the choroidal neovascularization is <4 MPS [macular photocoagulation study] disc areas in size when the vision is >20/50
- Juxtafoveal choroidal neovascularization is an off-label indication for PDT but may be considered in select cases.”
National Comprehensive Cancer Network – 2020
Ocular Photodynamic Therapy
- There is no recommendation to treat uveal melanoma with ocular PDT mentioned in the NCCN guidelines.
- Consider additional treatment with resection, laser ablation, transpupillary thermotherapy, or cryotherapy if concerned that adequate response was not achieved from initial radiation.
- For small recurrences in [individuals] who cannot undergo radiation therapy or surgery, transpupillary thermotherapy is recommended.