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 AMD document has been developed by eye health-care professionals and patient representatives, the Action on AMD group. 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.

Figure 1

Patient pathway for expanded non-consultant roles (Gloucestershire example). AMD, age-related macular degeneration; BIO, biomicroscopy; FFA, fundus fluorescein angiogram; IOP, intraocular pressure; OCT, optical coherence tomography; VA, visual acuity.

Figure 2

Mobile Community Eye Care Clinic patient pathway (York example). BIO, biomicroscopy; BP, blood pressure; IOP, intraocular pressure; OCT, optical coherence tomography.

Figure 3

Nurse-led and virtual patient pathway (Sheffield example). AMD, age-related macular degeneration; BRVO, branch retinal vein occlusion; CSR, central serous retinopathy; FA, fluorescein angiography; ICG, indocyanine green angiography; IVT, intravitreal treatment; OCT, optical coherence tomography; VA, visual acuity.

Figure 4

Hub and mobile OCT spoke model (Southampton example). AMD, age-related macular degeneration; IVT, intravitreal treatment; OCT, optical coherence tomography; VA, visual acuity.

Figure 5

(a) Hub and satellite clinic spoke (Sunderland example). The pathway for newly diagnosed patients and patients with ‘active' wet AMD. AMD, age-related macular degeneration; FFA, fundus fluorescein angiography; IVT, intravitreal treatment; MR, medical retinal; OCT, optical coherence tomography; VA, visual acuity; VEGF, vascular endothelial growth factor.

Figure 5

(a) Hub and satellite clinic spoke (Sunderland example). The pathway for newly diagnosed patients and patients with ‘active' wet AMD. AMD, age-related macular degeneration; FFA, fundus fluorescein angiography; IVT, intravitreal treatment; MR, medical retinal; OCT, optical coherence tomography; VA, visual acuity; VEGF, vascular endothelial growth factor.

Figure 6

Telemedicine with community imaging (new vs old Fife patient pathways). Adapted from Cameron et al. with permission from the Nature Publishing Group. GP, general practitioner; HES, hospital eye service.

Figure 7

Community OCT telemedicine (example from Salford/Bolton). OCT, optical coherence tomography. Reprinted from Kelly et al. Copyright 2011, with permission from Dove Medical Press Ltd.