Table 1 Action on nAMD service provision: key points

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

• Recommendations for service providers
° Maintain high-quality service provision standards without compromise for target time to treat, maintenance of review intervals for timely proactive treatment and appropriate discharge.
° Ensure continuing proactive treatment strategies to maximise and maintain vision benefits.
° Monitor and benchmark treatment outcomes, attendance compliance and discharge rates in the context of service slippage.
° Ensure dedicated ophthalmic IT and failsafe administration support.
Practices to meet current and future demand
° Service providers are encouraged to establish a service model best suited to local circumstances and patient population but which allows patients with nAMD to receive timely and effective treatment with optimal follow-up.
° An efficient MDT with upskilled AHPs helps optimise available consultant resource.
° Examples of good practice and service development include clinical assessments and evaluation of images undertaken by trained AHPs under the supervision of a retinal specialist with expertise in managing nAMD, non-medical healthcare professional-led intravitreal injection services and follow-up clinics in the community for surveillance of treated nAMD patients with quiescent disease.
° Consultation based on SD-OCT images acquired either by community optometrists or AHPs within the HES may help to triage individuals with suspected macular disease and provide faster access to treatment for urgent cases.
° Fast and secure IT links are necessary.
° For nAMD patients with quiescent disease following anti-VEGF treatment, consider the feasibility of utilising community-based optometrists to make decisions about the need for hospital assessment and treatment, subject to ongoing training and consultant-led governance.
Group review of NICE guideline for diagnosis and management of AMD
° NICE technology appraisal recommendations must normally be implemented by the NHS within 90 days of the date of publication of final guidance, unless otherwise specified. By contrast, it is not mandatory to apply the recommendations in NICE guideline NG82.
° NICE does not recommend the routine use of ICGA as part of the diagnostic and therapeutic processes, but acknowledges that it is considered particularly useful for identifying PCV, a subtype of nAMD.
° There is an opportunity to seek commissioning support for antiangiogenic treatment of nAMD patients with starting vision better than 6/12 or if vision is worse than 6/96 in a second eye.
° There may be a role for adjunctive PDT in individual nAMD cases, while laser may be a potential treatment option for extrafoveal CNV lesions.
° Effective low-vision support services are necessary as part of routine care and all medical retina units should have access to LVA services.
° Centres should seek funding for an ECLO service where absent.
  1. AHPs allied healthcare professionals, anti-VEGF anti-vascular endothelial growth factor, CNV choroidal neovascularisation, ECLO Eye Clinic Liaison Officer, LVA low-vision aid, HES hospital eye service, MDT multidisciplinary team, ICGA indocyanine green angiography, nAMD neovascular age-related macular degeneration, NICE National Institute for Health and Care Excellence, PCV polypoidal choroidal vasculopathy, PDT photodynamic therapy, SD-OCT spectral domain optical coherence tomography