The letter written by Dr Margaret Ewart (p 1083), a retired general practitioner who has age related macular degeneration (AMD), coincides with the publication of the document “ Age Related Macular Degeneration, Best Clinical Practice Guidelines” by the Royal College of Ophthalmologists.1 Both the letter and the guidelines highlight a number of common issues.

A recognised scenario in the United Kingdom is the elderly patient with loss of vision in one eye due to AMD who presents to her general practitioner with symptoms of distortion of vision in her other eye. The referral letter from the general practitioner seeks a routine appointment and by the time the patient is seen she has a subfoveal neovascular membrane with a visual acuity of 6/24. A verbal description of the disorder is given and she is told that “there is nothing we can …