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## Complete Summary

#### GUIDELINE TITLE

Guidance on the use of photodynamic therapy for age-related macular
degeneration.

#### BIBLIOGRAPHIC SOURCE(S)

National Institute for Clinical Excellence (NICE). Guidance on the use
of photodynamic therapy for age-related macular degeneration. London
(UK): National Institute for Clinical Excellence (NICE); 2003 Sep. 26
p. (Technology appraisal; no. 68).

#### GUIDELINE STATUS

This is the current release of the guideline.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 CONTRAINDICATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Age-related macular degeneration (ARMD)

#### GUIDELINE CATEGORY

Assessment of Therapeutic Effectiveness\
Treatment

#### CLINICAL SPECIALTY

Family Practice\
Geriatrics\
Internal Medicine\
Ophthalmology\
Optometry

#### INTENDED USERS

Advanced Practice Nurses\
Health Plans\
Managed Care Organizations\
Optometrists\
Physician Assistants\
Physicians\
Public Health Departments\
Utilization Management

#### GUIDELINE OBJECTIVE(S)

To establish the clinical and cost-effectiveness of photodynamic therapy
(PDT) for the neovascular form of wet age-related macular degeneration
(ARMD)

#### TARGET POPULATION

Adult patients (18 or over) with the neovascular form of wet age-related
macular degeneration (ARMD)

#### INTERVENTIONS AND PRACTICES CONSIDERED

Photodynamic therapy

**Note**: At present only verteporfin (Visudyne), a benzoporphyrin
derivative, is available for this indication, but other agents are in
development

#### MAJOR OUTCOMES CONSIDERED

-   Clinical effectiveness

    -   Visual acuity

    -   Contrast sensitivity

    -   Quality of life

    -   Side effects of treatment

-   Cost effectiveness

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Hand-searches of Published Literature (Primary Sources)\
Hand-searches of Published Literature (Secondary Sources)\
Searches of Electronic Databases\
Searches of Unpublished Data

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

**Note from the National Guideline Clearinghouse (NGC)**: The National
Institute for Health and Clinical Excellence (NICE) commissioned an
independent academic centre to perform a systematic literature review on
the technology considered in this appraisal and prepare an assessment
report. The assessment report for this appraisal was prepared by the
West Midlands Health Technology Assessment Group, Department of Public
Health and Epidemiology, The University of Birmingham (see the
\"Companion Documents\" field).

**Clinical Effectiveness Review**

**Data Sources**

As the authors of the Assessment Report had completed a systematic
review on the same subject within the previous year, no formal scoping
search was undertaken. This systematic review was used as the basis for
the protocol for this technology assessment, which was undertaken in
accordance with the pre-defined protocol. The following sources were
searched:

-   Bibliographic databases: Cochrane Library 2001 Issue 3; MEDLINE
    (Ovid) 1993-Aug 2001; EMBASE (Ovid) 1993-Aug 2001; Science Citation
    Index (Web of Science) 1993-Sept 2001; National Research Register
    and MRC current controlled trials register - September 2001

-   National and international health technology assessment (HTA) sites
    \-- (International Association for Health Technology Assessment
    \[INAHTA\], National Horizon Scanning Centre \[NHSC\], Canadian
    Co-ordinating Office for Health Technology Assessment \[CCOHTA\],
    Danish Institute for Health Technology Assessment \[DIHTA\],
    Norwegian Centre for Health Technology Assessment \[SMM\], July
    2001)

-   Conference abstracts, (Association for Research in Vision and
    Ophthalmology \[ARVO\] 1999, 2000, 2001, European Society of
    Ophthalmology \[SOE\] 2001)

-   Internet sites (Novartis, Visudyne. \[Novartis Ophthalmics,
    Switzerland\])

-   Citations of all relevant articles found and the data outline sent
    to us by Novartis separately from the industry submission.

**Inclusion and Exclusion Criteria**

One reviewer, using explicit predetermined criteria, made the inclusion
and exclusion decisions. These were checked by a second reviewer.
Inclusion and exclusion decisions were made independently of the
inspection of trial results.

Trials and studies were only included if they met the following
criteria:

-   Study design: Randomised controlled trials

-   Population: Adults with wet age-related macular degeneration (ARMD)

-   Intervention: Photodynamic therapy (PDT) using any photosensitive
    drug

-   Comparator: Either no treatment (best supportive care) for subfoveal
    lesions or laser photocoagulation for juxtafoveal or extrafoveal
    lesions

-   Outcomes: Any of visual acuity, contrast sensitivity, quality of
    life, side effects of treatment

-   Reporting: Only trials where recruitment had closed and which
    reported follow up results for all or nearly all recruited patients
    were included

The exclusion criteria were:

1.  Randomised controlled trials (RCT) that had not finished recruiting

2.  RCTs that had published only baseline characteristics or follow up
    results for a small proportion of the trial participants

3.  Studies carried out on animals

Although items 1, 2 and 3 above were excluded from the analysis of
clinical effectiveness, their presence was noted as essential background
to the review. Note that although new treatments (anecortave acetate and
transpupillary thermotherapy \[TTT\]) are potential comparators to PDT,
it was considered that their development is at too early a stage to
merit listing in the inclusion criteria.

**Costs and Cost Effectiveness Review**

A systematic review of the literature on costs, health economic impact
and generic quality of life outcomes of PDT for AMD was carried out.
Costs studies include studies reporting primary research on the costs
and utilisation of care and cost studies that discuss economic aspects
of care and contain useful primary or secondary cost or utilisation
data.

The review of economic studies followed the method of Mugford and has
subsequently been established in other reviews.

**Search**

A specific search strategy for information on costs, cost effectiveness
and quality of life involved searches of:

-   Bibliographic databases: MEDLINE (Ovid) 1993-Aug 2001; NHS Economic
    Evaluation Database (NHS EED) and the NHS Database of Reviews of
    Effectiveness (DARE)

-   Internet sites of national economics units

Relevant information found during the clinical effectiveness searches
was also used. Any economic analysis submitted as part of the Industry
submission to NICE could also potentially be included.

The search was broadened to find information to inform the economic
model. Searches focused on finding relevant economic information on
laser photocoagulation and other possible treatments for AMD, the
natural course of wet AMD without treatment and of the consequences of
blindness.

**Inclusion and Exclusion Criteria, Data Extraction and Quality
Assessment**

One reviewer, using explicit predetermined criteria, made the inclusion
and exclusion decisions for the cost effectiveness review and this was
checked by a second researcher. Studies were only included if they met
the following criteria:

-   Study design: Any study type

-   Population: Adults with any AMD

-   Intervention: PDT using any photosensitive drug

-   Outcomes: Costs, cost consequences, cost utility, cost effectiveness
    or any generic quality of life

One researcher extracted data from the included studies and a second
researcher again checked this.

There were 3 stages used for the review of cost and economic studies. In
Stage 1 each study was categorised by one of the investigators on the
basis of its title and abstract where available, according to five
classification criteria. Studies that were categorised into the relevant
classification for this review proceeded to Stage 2. In Stage 2 all
potentially relevant studies were read in full and further classified.
All papers confirmed as being relevant to this review proceeded to Stage
3. In Stage 3 all relevant articles were assessed according to
predetermined quality criteria. The quality of the economic evaluations
was assessed according to predetermined criteria. The quality of the
cost studies was assessed using predetermined criteria.

#### NUMBER OF SOURCE DOCUMENTS

**Clinical Effectiveness**

The clinical effectiveness searches identified 417 references.  Six
randomised controlled trials (RCTs) of photodynamic therapy (PDT) in wet
age-related macular degeneration (AMD) were ultimately found of which
four are ongoing and two completed. These six were considered as
included for the purposes of demonstrating coverage of areas relevant to
current and future assessment of the effectiveness of PDT in wet AMD.
Only the two completed were considered as included for the purposes of
analysing the current evidence on effectiveness of PDT for wet AMD.

**Cost Effectiveness**

In brief the search identified 64 (plus 7 duplicates) articles that were
potentially relevant to this review. Five papers were identified by
other means such as personal communications. Only two economic
evaluations reached Stage 3 of the review. Both passed the quality
assessment and are included. Four cost studies were identified initially
but only 3 reached Stage 3 of the review and none of them passed the
quality assessment stage. Details of these three studies are given in
Appendix 9 of the Assessment Report (see \"Companion Documents\" field.

Thus two studies were included, to which was added the economic analysis
section of the industry submission to the National Institute for Health
and Clinical Excellence (NICE).

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Expert Consensus

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Not applicable

#### METHODS USED TO ANALYZE THE EVIDENCE

Systematic Review with Evidence Tables

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

**Note from the National Guideline Clearinghouse (NGC)**: The National
Institute for Health and Clinical Excellence (NICE) commissioned an
independent academic centre to perform a systematic literature review on
the technology considered in this appraisal and prepare an assessment
report. The assessment report for this appraisal was prepared by the
West Midlands Health Technology Assessment Group, Department of Public
Health and Epidemiology, The University of Birmingham (see the
\"Companion Documents\" field).

**Data Extraction and Quality Assessment Strategies**

Two researchers independently extracted the effectiveness and quality
assessment data from all included studies, using predefined criteria.
Any discrepancies were recorded and resolved by discussion. The quality
of the included studies was assessed using the Jadad scale.

**Synthesis of Results**

The main method of synthesis was qualitative, supplemented by further
quantitative analysis and synthesis where appropriate using Review
Manager software version 4.1.

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Expert Consensus

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

**Considerations**

Technology appraisal recommendations are based on a review of clinical
and economic evidence.

**Technology Appraisal Process**

The National Institute for Health and Clinical Excellence (NICE) invites
\'consultee\' and \'commentator\' organisations to take part in the
appraisal process. Consultee organisations include national groups
representing patients and carers, the bodies representing health
professionals, and the manufacturers of the technology under review.
Consultees are invited to submit evidence during the appraisal and to
comment on the appraisal documents.

Commentator organisations include manufacturers of the products with
which the technology is being compared, the National Health Service
(NHS) Quality Improvement Scotland and research groups working in the
area. They can comment on the evidence and other documents but are not
asked to submit evidence themselves.

NICE then commissions an independent academic centre to review published
evidence on the technology and prepare an \'assessment report\'.
Consultees and commentators are invited to comment on the report. The
assessment report and the comments on it are then drawn together in a
document called the evaluation report.

An independent Appraisal Committee then considers the evaluation report.
It holds a meeting where it hears direct, spoken evidence from nominated
clinical experts, patients and carers. The Committee uses all the
evidence to make its first recommendations, in a document called the
\'appraisal consultation document\' (ACD). NICE sends all the consultees
and commentators a copy of this document and posts it on the NICE
website. Further comments are invited from everyone taking part.

When the Committee meets again it considers any comments submitted on
the ACD; then it prepares its final recommendations in a document called
the \'final appraisal determination\' (FAD). This is submitted to NICE
for approval.

Consultees have a chance to appeal against the final recommendations in
the FAD. If there are no appeals, the final recommendations become the
basis of the guidance that NICE issues.

**Who is on the Appraisal Committee?**

NICE technology appraisal recommendations are prepared by an independent
committee. This includes health professionals working in the NHS and
people who are familiar with the issues affecting patients and carers.
Although the Appraisal Committee seeks the views of organisations
representing health professionals, patients, carers, manufacturers and
government, its advice is independent of any vested interests.

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

#### COST ANALYSIS

**Cost Effectiveness**

The Appraisal Committee considered three estimates of the cost
effectiveness of verteporfin photodynamic therapy (PDT): one was
performed by the Assessment Group, another was commissioned by the
manufacturer and submitted for this appraisal, and a third was found in
the published literature. All three evaluations expressed the benefits
of treatment in terms of quality adjusted life years (QALYs). The values
of the QALYs were derived from a study that related utility
(health-related quality of life) to visual acuity in the better-seeing
eye. Thus, the assumption that patients were receiving treatment in
their better-seeing eye was inherent in all the analyses. The analyses
by the Assessment Group and in the manufacturer\'s submission included
costs to the National Health Service (NHS) and personal social services.
The published study was from North America, and the costs included in
that assessment reflect the organization of healthcare in the United
States. This limited its applicability to the evaluation of cost
effectiveness in the NHS.

See Section 4.2 of the original guideline document for a detailed
discussion of the cost-effectiveness analysis.

#### METHOD OF GUIDELINE VALIDATION

External Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

Consultee organizations from the following groups were invited to
comment on the draft scope, Assessment Report and the Appraisal
Consultation Document (ACD) and were provided with the opportunity to
appeal against the Final Appraisal Determination.

-   Manufacturer/sponsors

-   Professional/specialist and patient/carer groups

-   Commentator organisations (without the right of appeal)

In addition, individuals selected from clinical expert and patient
advocate nominations from the professional/specialist and patient/carer
groups were also invited to comment on the ACD.

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

-   Photodynamic therapy (PDT) is recommended for the treatment of wet
    age-related macular degeneration for individuals who have a
    confirmed diagnosis of **classic with no occult** subfoveal
    choroidal neovascularisation (CNV) (that is, whose lesions are
    composed of classic CNV with no evidence of an occult component) and
    best-corrected visual acuity 6/60 or better. PDT should be carried
    out only by retinal specialists with expertise in the use of this
    technology.

-   PDT is not recommended for the treatment of people with
    **predominantly classic** subfoveal CNV (that is, 50% or more of the
    entire area of the lesion is classic CNV but some occult CNV is
    present) associated with wet age-related macular degeneration,
    except as part of ongoing or new clinical studies that are designed
    to generate robust and relevant outcome data, including data on
    optimum treatment regimens, long-term outcomes, quality of life, and
    costs.

-   The use of PDT in **occult** CNV associated with wet age-related
    macular degeneration was not considered because the photosensitising
    agent (verteporfin) was not licensed for this indication when this
    appraisal began. No recommendation is made with regard to the use of
    this technology in people with this form of the condition.

-   Patients currently receiving treatment with PDT could experience
    loss of well-being if their treatment is discontinued at a time they
    did not anticipate. Because of this, all National Health Service
    (NHS) patients who have begun a course of treatment with PDT at the
    date of publication of this guidance should have the option of
    continuing to receive treatment until their clinical condition
    indicates that it is appropriate to stop.

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of evidence supporting the recommendations is not specifically
stated.

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

Appropriate use of photodynamic therapy for treatment of age-related
macular degeneration

#### POTENTIAL HARMS

Some patients treated with verteporfin photodynamic therapy (PDT) have
reported visual disturbances (abnormal vision, decreased vision, visual
field defect) after treatment. Some of these disturbances involved
severe loss of vision. In most patients who experienced severe loss of
vision after verteporfin PDT there was partial or complete recovery of
vision to baseline values. Other adverse effects reported in clinical
trials of verteporfin PDT included infusion-related pain\--primarily
presenting as back pain\--and photosensitivity reactions in the form of
sunburn following exposure to sunlight, usually within 24 hours of
treatment.

For full details of side effects and contraindications, see the Summary
of Product Characteristics available at <http://emc.medicines.org.uk/>.

### CONTRAINDICATIONS

#### CONTRAINDICATIONS

Verteporfin is contra-indicated in patients with porphyria, severe liver
impairment, or known hypersensitivity to verteporfin or any other
component of the infusion, including egg proteins, or who are
breastfeeding. It is produced from porcine hemin as a starting material
so vegetarians and people of Muslim and Jewish faiths should be
notified. It should not be used in people with uncontrolled high blood
pressure, unstable cardiovascular disease, active hepatitis or moderate
to severe liver disease. Concomitant medications that reduce the
effectiveness of liver catabolism may prolong systemic photosensitivity.

For full details of side effects and contraindications, see the Summary
of Product Characteristics available at <http://emc.medicines.org.uk/>.

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

This guidance represents the view of the Institute, which was arrived at
after careful consideration of the available evidence. Health
professionals are expected to take it fully into account when exercising
their clinical judgment. This guidance does not, however, override the
individual responsibility of health professionals to make appropriate
decisions in the circumstances of the individual patient, in
consultation with the patient and/or guardian or carer.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

-   Clinicians who provide care for people with wet age-related macular
    degeneration (ARMD) should review local practice and policies
    regarding the use of photodynamic therapy (PDT) to take account of
    the guidance (see \"Major Recommendations\" field).

-   Local guidelines, protocols or care pathways that refer to the care
    of people with wet ARMD should incorporate the guidance in Section 1
    of the original guideline.

-   To measure compliance locally with the guidance, the following
    criteria can be used. Further details on suggestions for audit are
    presented in Appendix C of the original guideline.

    -   PDT is provided to individuals with wet ARMD in either of the
        following circumstances.

        -   The individual has a confirmed diagnosis of classic with no
            occult subfoveal choroidal neovascularisation (CNV) and
            best-corrected visual acuity 6/60 or better.

        -   The individual is receiving treatment with PDT at the date
            of publication of this guidance and opts to continue to
            receive treatment until his or her clinical condition
            indicates that it is appropriate to stop.

    -   PDT is carried out only by a retinal specialist with expertise
        in its use.

    -   An individual who has predominantly classic CNV associated with
        wet ARMD and is not already receiving treatment is not provided
        with PDT, unless the individual is participating in an
        appropriately designed clinical study.

#### IMPLEMENTATION TOOLS

Audit Criteria/Indicators\
Patient Resources\
Quick Reference Guides/Physician Guides

For information about
[availability](#identifying-information-and-availability), see the
\"Availability of Companion Documents\" and \"Patient Resources\" fields
below.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Getting Better

#### IOM DOMAIN

Effectiveness\
Patient-centeredness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

National Institute for Clinical Excellence (NICE). Guidance on the use
of photodynamic therapy for age-related macular degeneration. London
(UK): National Institute for Clinical Excellence (NICE); 2003 Sep. 26
p. (Technology appraisal; no. 68).

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

2003 Sep

#### GUIDELINE DEVELOPER(S)

National Institute for Health and Clinical Excellence (NICE) - National
Government Agency \[Non-U.S.\]

#### SOURCE(S) OF FUNDING

National Institute for Health and Clinical Excellence (NICE)

#### GUIDELINE COMMITTEE

Appraisal Committee

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*Committee Members*: Dr Jane Adam, Radiologist, St George\'s Hospital,
London; Dr Sunil Angris, General Practitioner, Waterhouses Medical
Practice, Staffordshire; Dr Darren Ashcroft, Senior Clinical Lecturer,
School of Pharmacy and Pharmaceutical Sciences, University of
Manchester; Professor David Barnett (*Chair*) Professor of Clinical
Pharmacology, University of Leicester; Professor Carol Black (up to June
2002) Consultant Physician, Royal Free Hospital & University College
London; Professor John Brazier, Health Economist, University of
Sheffield; Professor John Cairns, Professor of Health Economics, Health
Economics Research Unit, University of Aberdeen; Professor Mike
Campbell, Statistician, Institute of General Practice & Primary Care,
Sheffield; Dr Peter I Clark, Consultant Medical Oncologist,
Clatterbridge Centre for Oncology, Wirral, Merseyside; Dr Mike Davies,
Consultant Physician, University Department of Medicine & Metabolism,
Manchester Royal Infirmary; Professor Cam Donaldson, PPP Foundation
Professor of Health Economics, School of Population and Health Sciences
& Business School, Business School \-- Economics, University of
Newcastle upon Tyne; Professor Jack Dowie, Health Economist, London
School of Hygiene; Dr Paul Ewings, Statistician, Taunton & Somerset NHS
Trust, Taunton; Ms Sally Gooch, Director of Nursing, Mid-Essex Hospital
Services NHS Trust, Chelmsford; Professor Trisha Greenhalgh, Professor
of Primary Health Care, University College London; Miss Linda Hands,
Clinical Reader in Surgery, University of Oxford; Ms Ruth Lesirge, Lay
Representative, previously Director, Mental Health Foundation, London;
Dr George Levvy, Lay Representative, Chief Executive, Motor Neurone
Disease Association, Northampton; Dr Gill Morgan, Chief Executive, NHS
Confederation, London; Professor Miranda Mugford (up to November 2002)
Health Economist, University of East Anglia, Norwich; Ms Siân Richards
(up to December 2002) Chief Executive, Cardiff Local Health Board; 
Professor Philip Routledge, Professor of Clinical Pharmacology, College
of Medicine, University of Wales, Cardiff; Dr Rhiannon Rowsell, (up to
December 2002) Medical & Regulatory Affairs, Director, AstraZeneca UK
Ltd, Luton; Dr Stephen Saltissi, Consultant Cardiologist, Royal
Liverpool University Hospital; Mr Miles Scott, Chief Executive,
Harrogate Health Care NHS Trust; Professor Andrew Stevens (*Vice-Chair*)
Professor of Public Health, University of Birmingham; Professor Ray
Tallis (up to January 2003) Consultant Physician, Hope Hospital,
Salford; Professor Mary Watkins, Professor of Nursing, University of
Plymouth; Dr Norman Waugh, Department of Public Health, University of
Aberdeen

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Committee members are asked to declare any interests in the technology
to be appraised. If it is considered there is a conflict of interest,
the member is excluded from participating further in that appraisal.

#### GUIDELINE STATUS

This is the current release of the guideline.

#### GUIDELINE AVAILABILITY

Electronic copies: Available in Portable Document Format (PDF) format
from the [National Institute for Health and Clinical Excellence (NICE)
Web
site](http://www.nice.org.uk/guidance/index.jsp?action=byID&o=11512).

#### AVAILABILITY OF COMPANION DOCUMENTS

The following are available:

-   Photodynamic therapy for age-related macular degeneration. Summary.
    London (UK): National Institute for Health and Clinical Excellence
    (NICE); 2003 Sep. 2 p. (Technology appraisal 68). Available in
    Portable Document Format (PDF) from the [National Institute for
    Health and Clinical Excellence (NICE) Web
    site](http://www.nice.org.uk/guidance/index.jsp?action=download&o=32729).

-   Clinical effectiveness and cost utility of photodynamic therapy for
    wet age-related macular degeneration. Assessment report. NHS R&D HTA
    Programme; 2002 Jan. 109 p. Available in Portable Document Format
    (PDF) from the [National Institute for Health and Clinical
    Excellence (NICE) Web
    site](http://www.nice.org.uk/guidance/index.jsp?action=download&o=32733).

Print copies: Available from the National Health Service (NHS) Response
Line 0870 1555 455. ref: N0304. 11 Strand, London, WC2N 5HR.

Additionally, Audit Criteria can be found in Appendix C of the [original
guideline
document](http://www.nice.org.uk/guidance/index.jsp?action=byID&o=11512).

#### PATIENT RESOURCES

The following is available:

-   The use of photodynamic therapy for age-related macular
    degeneration. Understanding NICE guidance \-- information for people
    with age-related macular degeneration, their families and carers,
    and the public. London (UK): National Institute for Health and
    Clinical Excellence (NICE); 2003 Sep. 14 p. (Technology appraisal
    68).

Electronic copies: Available in Portable Document Format (PDF) from the
[National Institute for Health and Clinical Excellence (NICE) Web
site](http://www.nice.org.uk/guidance/index.jsp?action=download&o=32731).

Print copies: Available from the Department of Health Publications Order
Line 0870 1555 455. ref: N0305. 11 Strand, London, WC2N 5HR.

Please note: This patient information is intended to provide health
professionals with information to share with their patients to help them
better understand their health and their diagnosed disorders. By
providing access to this patient information, it is not the intention of
NGC to provide specific medical advice for particular patients. Rather
we urge patients and their representatives to review this material and
then to consult with a licensed health professional for evaluation of
treatment options suitable for them as well as for diagnosis and answers
to their personal medical questions. This patient information has been
derived and prepared from a guideline for health care professionals
included on NGC by the authors or publishers of that original guideline.
The patient information is not reviewed by NGC to establish whether or
not it accurately reflects the original guideline\'s content.

#### NGC STATUS

This NGC summary was completed by ECRI on June 28, 2006.

The National Institute for Health and Clinical Excellence (NICE) has
granted the National Guideline Clearinghouse (NGC) permission to include
summaries of their Technology Appraisal guidance with the intention of
disseminating and facilitating the implementation of that guidance. NICE
has not verified this content to confirm that it accurately reflects the
original NICE guidance and therefore no guarantees are given by NICE in
this regard. All NICE technology appraisal guidance is prepared in
relation to the National Health Service in England and Wales. NICE has
not been involved in the development or adaptation of NICE guidance for
use in any other country. The full versions of all NICE guidance can be
found at [www.nice.org.uk](http://www.nice.org.uk/).

#### COPYRIGHT STATEMENT

This NGC summary is based on the original guideline, which is subject to
the guideline developer\'s copyright restrictions.

### DISCLAIMER

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Date Modified: 11/3/2008