Research published in BMJ Open today has found that community care for routine monitoring of neovascular age-related macular degeneration can be just as effective as hospital-based care.
Wet, or neovascular age-related macular degeneration (nAMD) is a common eye condition that affects over 600,000 people in the UK. It's caused by blood vessels growing in the eye and leads to severe sight loss and blindness. It's treated using medication that's injected into the eye.
Patients with the condition are monitored to ensure that the problem doesn't come back. Monitoring is ongoing, almost always in hospital out-patient departments. To ease the growing pressure on hospital eye services, there has been interest in sharing the responsibility for monitoring with optometrists in private practice in the community, such as those in local high-street opticians.
Researchers, funded by the NIHR, have looked at the likely effectiveness of sharing care with optometrists compared to the care provided by eye doctors working in hospital eye services. They have recruited eye doctors with experience in the age-related macular degeneration service and optometrists not participating in nAMD care. The trial is unusual in that it is based online with eye doctors and optometrists (the participants) making decisions based on vignettes rather than real patients.
Overall, the research team, led by Professor Usha Chakravarthy of The Queen's University of Belfast, found that the decisions made by ophthalmologists and optometrists were consistent and that after training, optometrists based in the community were as good as hospital-based ophthalmologists. The research team note that optometrists tended to be more cautious, being more ready to say that nAMD had returned. This meant that they made more false positive errors but correctly identified more patients in whom nAMD had truly returned. Nevertheless, overall they classified vignettes as accurately as the eye doctors.
"Sharing care has the potential to reduce workload in hospitals" commented Professor Chakravarthy. "Our research has highlighted that routine monitoring of nAMD can effectively take place in the community, which not only frees up hospital appointments, but is often more convenient for patients."
Article: Effectiveness of Community versus Hospital Eye Service follow-up for patients with neovascular age-related macular degeneration with quiescent disease (ECHoES): a virtual non-inferiority trial, Barnaby C Reeves, Lauren J Scott, Jodi Taylor, Simon P Harding, Tunde Peto, Alyson Muldrew, Ruth E Hogg, Sarah Wordsworth, Nicola Mills, Dermot O'Reilly, Chris A Rogers, Usha Chakravarthy, BMJ Open, doi:10.1136/bmjopen-2015-010685, published 8 July 2016.