Action on neovascular age-related macular degeneration (nAMD): recommendations for management and service provision in the UK hospital eye service

Gale, Richard; Mahmood, Sajjad; Devonport, Helen; Patel, Praveen J; Ross, Adam H; Walters, Gavin; Downey, Louise; Elsherbiny, Samer; Freeman, M.; Berry, Simon; Jain, Nitin B.

doi:10.1038/s41433-018-0300-3

Cited by 47 publications

(57 citation statements)

References 73 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Neovascular age-related macular degeneration (nAMD) is a chronic condition requiring regular monitoring and treatment [ 1 ]. The prevalence of nAMD in the UK in 2012 was ~2.4%, with an estimated 39,700 new cases diagnosed per year [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…Increasing age is a risk factor for nAMD, therefore disease prevalence and demand for treatment is expected to rise with an ageing population [ 1 , 2 ]. The number of nAMD cases in the UK is predicted to rise by 59% from 2015 to 2035 [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…The number of nAMD cases in the UK is predicted to rise by 59% from 2015 to 2035 [ 4 ]. Growing treatment demand has resulted in increasing strain on the capacity of the AMD service, threatening the delivery of optimal care to patients [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Recommendations by a UK expert panel on an aflibercept treat-and-extend pathway for the treatment of neovascular age-related macular degeneration

Ross

Downey

Devonport

et al. 2020

Eye

Self Cite

View full text Add to dashboard Cite

Objectives This report aims to provide clear recommendations and practical guidance from a panel of UK retinal experts on an aflibercept treat-and-extend (T&E) pathway that can be implemented in clinical practice. These recommendations may help service providers across the NHS intending to implement a T&E approach, with the aim of effectively addressing the capacity and resource issues putting strain on UK neovascular age-related macular degeneration (nAMD) services while promoting patients' best interests throughout. Methods Two structured roundtable meetings of retinal specialists were held in London, UK on 7 December 2018 and 1 March 2019. These meetings were organised and funded by Bayer. Results The panel provided recommendations for an aflibercept T&E pathway and developed specific criteria based on visual acuity, retinal morphology and optical coherence tomography imaging to guide reduction, maintenance and extension of injection intervals. They also discussed the extension of treatment intervals by 2-or 4-week adjustments to a maximum treatment interval of 16 weeks, the management of retinal fluid and the stopping of treatment. Conclusions The long-term benefits of implementing a T&E pathway may include superior visual outcomes compared with a pro re nata (PRN; as needed) protocol, and a lower treatment burden compared with a fixed protocol, which is likely to improve service capacity. Furthermore, the predictable nature of a T&E approach compared with a PRN service may aid capacity planning for the future nAMD treatment demand.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Recommendations by a UK expert panel on an aflibercept treat-and-extend pathway for the treatment of neovascular age-related macular degeneration

Ross

Downey

Devonport

et al. 2020

Eye

Self Cite

View full text Add to dashboard Cite

show abstract

“…Furthermore, the first role of a nurse in charge of triage is to briefly assess the patients within five to ten minutes, in a case where there is no overcrowding, the nurse can reassess patients based on his or her discretion [ 18 ]. Conversely, the average length of time to triage a patient was five minutes but there is a significant increase in triage time when patients are triaged to a specialty, expected by a specialty, or were actively “seen and treated” in triage [ 19 ]. Another study shows that early prioritization of patients is another essential role of every nurse dealing with triage and a nurse can only make the right prioritization after he or she might have undergone some professional training in the triage system [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

A perception survey on the roles of nurses during triage in a selected public hospital in Kwazulu-Natal Province, South Africa

Olofinbiyi¹,

Dube²,

Mhlongo³

2020

Pan Afr Med J

View full text Add to dashboard Cite

Introduction triage is gradually becoming an autonomous nursing role essential to patients' safety and the efficient delivery of emergency care. The increased need for more holistic and advanced care during triage makes the role of nurses during triage highly indispensable. However, several studies have shown that nurse-led triage has been so successful over the years in most African countries and in other developing countries. South African Triage Scale (SATS) is an example of triage tool that was designed in such a way that the lowest cadre nurse can successfully implement. The success recorded by this tool made most African countries and some other developing countries adopt the tool. The study was designed to explore the roles of nurses during triage in a selected public hospital in KwaZulu-Natal province. Methods this study utilized a quantitative approach, in which a non-experimental survey involving convenience sampling technique was chosen as the most suitable sampling technique for the study. Recognition-primed decision model formed the framework of the study. Ethical clearance was obtained from University of KwaZulu-Natal Ethics Review Board and ethics principles were observed during the study. Results the result of the study indicated that majority (100%) of the respondents perceived that nurses have lots of roles to perform during triage. They further unveiled that it is highly paramount for nurses to manage the waiting room and control overcrowding in the unit. Conclusion the study draws on the need for qualified and experienced nurses to be in charge of these roles in order to reduce the mortality and morbidity rates that usually occur during triage administration.

show abstract

“…This capacity requirement has caused many hospital departments to expand and/or find new solutions to expand their services. The Royal College of Ophthalmologists (UK) made recommendations for management and service provision which includes the use of trained allied health professionals for patient assessments under the supervision of retinal specialists, non‐medical healthcare professional‐led intravitreal injection services and follow up clinic in the community for surveillance of treated nAMD patients with quiescent disease …”

Section: Introductionmentioning

confidence: 99%

Treatment decisions of UK hospital optometrists and ophthalmologists in patients with nAMD: a vignette study

Creer

Roberts

Aslam

et al. 2019

Ophthalmic Physiologic Optic

Self Cite

View full text Add to dashboard Cite

Purpose A vignette study to examine treatment decisions made by UK hospital optometrists in patients with neovascular age‐related macular degeneration (nAMD) and the effect of optometrists’ experience on agreement. Methods Patients with nAMD attending Manchester Royal Eye Hospital, Manchester, UK were identified as potential candidates for the case series of vignettes. The cases were chosen to reflect a varied case‐mix with respect to difficulty as well as ensuring good quality of the images. Each vignette included a history summary consisting of the number of previous injections given and visual acuity measurements at baseline, the previous visit, and the current visit. Images were compiled to show baseline fundus photographs and ocular coherence tomography (OCT) images with the current visit images on which the treatment decision was to be made along with the images from the previous visit. Hospital optometrists were recruited and asked to complete the series of vignettes, deciding if treatment was required at that visit and how confident they felt with that decision. Their responses were compared to the reference standard created by a consensus of consultant ophthalmologists with a sub‐speciality interest in medical retina. Results Regarding treatment decision for optometrists, the percentage correct value was 75% with the sensitivity being 75.6% (95% CI 70.1–80.3) and the specificity as 75.1% (95% CI 72.1–77.8). No statistically significant difference was found between differing levels of experience. However, there was a significant difference in confidence levels between groups. Potentially sight threatening decisions accounted for 6.4% of the optometrists’ decisions, 3.5% were made with a high confidence rating suggesting no discussion with an ophthalmologist was required. Conclusions Although the optometrists showed modest agreement with the reference standard in a series of cases that have higher than average complexity, the optometrists showed a similar amount of variability within their treatment decisions compared to the reference standard. The optometrists were therefore not inferior in their performance compared to the ophthalmologists and this can be seen as supporting evidence for their extended role within this clinical area. Experience did not have an effect on ‘correct’ treatment decisions although there was a statistically significant effect on increasing confidence of treatment decision.

show abstract

Action on neovascular age-related macular degeneration (nAMD): recommendations for management and service provision in the UK hospital eye service

Abstract: Disclaimer This publication and the expert roundtable meeting on which the article is based were sponsored by Bayer plc. Prescribing information for Eylea ® (aflibercept solution for injection) can be found at the end of the article.

Cited by 47 publications

References 73 publications

Recommendations by a UK expert panel on an aflibercept treat-and-extend pathway for the treatment of neovascular age-related macular degeneration

Recommendations by a UK expert panel on an aflibercept treat-and-extend pathway for the treatment of neovascular age-related macular degeneration

A perception survey on the roles of nurses during triage in a selected public hospital in Kwazulu-Natal Province, South Africa

Treatment decisions of UK hospital optometrists and ophthalmologists in patients with nAMD: a vignette study

Contact Info

Product

Resources

About