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. 2016 Jan;30(1):68-78.
doi: 10.1038/eye.2015.170. Epub 2015 Oct 9.

The design and implementation of a study to investigate the effectiveness of community vs hospital eye service follow-up for patients with neovascular age-related macular degeneration with quiescent disease

J Taylor  1 , L J Scott  1 , C A Rogers  1 , A Muldrew  2 , D O'Reilly  3 , S Wordsworth  4 , N Mills  5 , R Hogg  2 , M Violato  4 , S P Harding  6 , T Peto  7 , D Townsend  5 , U Chakravarthy  2 , B C Reeves  1
Affiliations

The design and implementation of a study to investigate the effectiveness of community vs hospital eye service follow-up for patients with neovascular age-related macular degeneration with quiescent disease

J Taylor et al. Eye (Lond). 2016 Jan.

Abstract

IntroductionStandard treatment for neovascular age-related macular degeneration (nAMD) is intravitreal injections of anti-VEGF drugs. Following multiple injections, nAMD lesions often become quiescent but there is a high risk of reactivation, and regular review by hospital ophthalmologists is the norm. The present trial examines the feasibility of community optometrists making lesion reactivation decisions.MethodsThe Effectiveness of Community vs Hospital Eye Service (ECHoES) trial is a virtual trial; lesion reactivation decisions were made about vignettes that comprised clinical data, colour fundus photographs, and optical coherence tomograms displayed on a web-based platform. Participants were either hospital ophthalmologists or community optometrists. All participants were provided with webinar training on the disease, its management, and assessment of the retinal imaging outputs. In a balanced design, 96 participants each assessed 42 vignettes; a total of 288 vignettes were assessed seven times by each professional group.The primary outcome is a participant's judgement of lesion reactivation compared with a reference standard. Secondary outcomes are the frequency of sight threatening errors; judgements about specific lesion components; participant-rated confidence in their decisions about the primary outcome; cost effectiveness of follow-up by optometrists rather than ophthalmologists.DiscussionThis trial addresses an important question for the NHS, namely whether, with appropriate training, community optometrists can make retreatment decisions for patients with nAMD to the same standard as hospital ophthalmologists. The trial employed a novel approach as participation was entirely through a web-based application; the trial required very few resources compared with those that would have been needed for a conventional randomised controlled clinical trial.

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Conflict of interest statement

CAR reports that she received a fee from Novartis for a lecture unrelated to this work. RH reports that she received grants and personal fees from Novartis, outside the submitted work. SPH reports grants from the National Institute for Health Research during the conduct of the study. BCR reports receiving grants from the NIHR HTA programme during the conduct of the study; NIHR grants (paying for his time through his academic employer) for various ophthalmological studies including ones investigating wet age-related macular degeneration; and personal fees from Janssen-Cilag outside the submitted work. In particular, he is a co-investigator on the NIHR-funded IVAN trial (ISRCTN92166560) and continuing follow-up of the IVAN trial cohort.

Figures

Figure 1
Figure 1
Example vignette.
Figure 2
Figure 2
Example responses, feedback summary, and query.
Figure 3
Figure 3
Participant flow. At the start of the trial, we were unsure of how many participants we would need to recruit in order to meet our target of 48 participants in each group. Therefore, we over recruited at the consent stage and asked a number of participants to complete the webinar and then ‘wait and see' whether we needed them to participate in the main trial. We also slightly over recruited at each stage of the trial to account for drop outs. This resulted in a small number of participants being withdrawn at various stages of the trial because they were no longer required.
See this image and copyright information in PMC

References

    1. 1Myint J, Edgar D, Kotecha A, Murdoch I, Lawrenson J. Barriers perceived by UK-based community optometrists to the detection of primary open angle glaucoma. Ophthalmic Physiol Opt 2010; 30: 847–853. - PubMed
    1. 2Brown DM, Kaiser PK, Michels M, Soubrane G, Heier JS, Kim RY et al. Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med 2006; 355(14): 1432–1444. - PubMed
    1. 3Rosenfeld PJ, Brown DM, Heier JS, Boyer DS, Kaiser PK, Chung CY et al. Ranibizumab for neovascular age-related macular degeneration. N Engl J Med 2006; 355(14): 1419–1431. - PubMed
    1. 4Banes MJ, Culham LE, Bunce C, Xing W, Viswanathan A, Garway-Heathm D. Agreement between optometrists and ophthalmologists on clinical management decisions for patients with glaucoma. Br J Ophthalmol 2006; 90(5): 579–585. - PMC - PubMed
    1. 5Hau S, Ehrlich D, Binstead K, Verma S. An evaluation of optometrists' ability to correctly identify and manage patients with ocular disease in the accident and emergency department of an eye hospital. Br J Ophthalmol 2007; 91(4): 437–440. - PMC - PubMed

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