Action on AMD. Optimising patient management: act now to ensure current and continual delivery of best possible patient care

Abstract

In recent years, there have been significant advances in the clinical management of patients with wet age-related macular degeneration (wet AMD)—a rapidly progressing and potentially blinding degenerative eye disease. Wet AMD is responsible for more than half of registered severe sight impairment (blindness) in the United Kingdom, and patients who are being treated for wet AMD require frequent and long-term follow-up for treatment to be most effective. The clinical workload associated with the frequent follow-up required is substantial. Furthermore, as more new patients are diagnosed and the population continues to age, the patient population will continue to increase. It is thus vital that clinical services continue to adapt so that they can provide a fast and efficient service for patients with wet AMD. This Action on AMDdocument has been developed by eye health-care professionals and patient representatives, the Action on AMDgroup. It is intended to highlight the urgent and continuing need for change within wet AMD services. This document also serves as a guide for eye health-care professionals, NHS commissioners, and providers to present possible solutions for improving NHS retinal and macular services. Examples of good practice and service development are considered and can be drawn upon to help services meet the recommended quality of care and achieve best possible outcomes.

Clinical characteristics and outcomes after 5 years pro re nata treatment of neovascular age‐related macular degeneration with ranibizumab

“…Being able to predict the outcome for an individual is important when counselling patients and planning services (Amoaku et al 2012). This retrospective real world study contributes to benchmarking of outcomes in the real world setting.…”

The Effectiveness, cost-effectiveness and acceptability of Community versus Hospital Eye Service follow-up for patients with neovascular age-related macular degeneration with quiescent disease (ECHoES): a virtual randomised balanced incomplete block trial

“…A recent review has outlined different approaches used to increase the capacity in nAMD services across the UK. 12 The case studies in this review show a variety of scenarios, with many involving extended roles for optometrists and nurse practitioners, but these occur within the HES.…”

“…In line with this research, studies exploring optometrists' perspectives of extending or enhancing their roles has highlighted a conflict between the retail and clinical sides of the optometric practice. 41,42 Amoaku et al 12 points out that the technology involved in monitoring nAMD, particularly an OCT, is expensive and optometrists would be unlikely to receive any grants for their purchase. An additional financial consideration was that there could an opportunity to save money with a reduced fee for optometrist rather than ophthalmologist monitoring, although commissioners expressed concerns about the possibility -and subsequent cost -of repeat testing by ophthalmologists who doubted optometrists' judgements when a patient was deemed to require retreatment.…”

“…Research has found an insufficiency of resources to deliver nAMD secondary care from the burden of follow-up visits required in patients with inactive nAMD. 12 Therefore, the health professionals agreed that shared care would relieve the ophthalmology workload. Shared care schemes are also attractive to patients who would find it more convenient to be monitored closer to their home.…”

“…34,35,39,40 Long-term research has demonstrated that recurrence of neovascular activity is common, 15 and any delay beyond the recommended interval may cause patients to unnecessarily lose vision permanently. 12 Given that vision can deteriorate in a short time if nAMD DOI: 10.3310/hta20800 HEALTH TECHNOLOGY ASSESSMENT 2016 VOL. 20 NO.…”