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

Research output: Contribution to journalReview article

  • Richard P. Gale
  • Sajjad Mahmood
  • Helen Devonport
  • Praveen J. Patel
  • Adam H. Ross
  • Gavin Walters
  • Louise Downey
  • Samer El-Sherbiny
  • Mary Freeman
  • Simon Berry
  • Nitin Jain
Original languageEnglish
Pages (from-to)1-21
Number of pages21
JournalEye
Volume33
Issue numberSuppl 1
Early online date29 Mar 2019
DOIs
DateE-pub ahead of print - 29 Mar 2019
DatePublished (current) - Mar 2019

Abstract

This report by a group of UK retina specialists and health professionals considers best practice recommendations for the management of sight-threatening neovascular age-related macular degeneration (nAMD), based on collective experience and expertise in routine clinical practice. The authors provide an update for ophthalmologists, allied healthcare professionals and commissioners on practice principles for optimal patient care and service provision standards. Refinement of care pathways for nAMD has improved access to intravitreal anti-vascular endothelial growth factor therapy but there are still variations in care and reported outcomes between clinic centres. Innovative organisational models of service provision allow providers to better match capacity with increasing demand. The authors review the recent NICE guideline for diagnosis and management of AMD, considerations for switching therapies and stopping treatment and need for regular monitoring of non-affected fellow eyes in patients with unilateral nAMD. Actions for delivery of high-quality care and to improve long-term patient outcomes are discussed. Local pathways need to detail nAMD target time to treat, maintenance of review intervals to ensure proactive treatment regimens are delivered on time and appropriate discharge for patients deemed low risk or no longer benefiting from treatment. Actual visual acuity outcomes achieved and maintenance of the level of vision when disease stability is achieved are considered good measures for judging the quality of care in the treatment of patients with nAMD. Robust community referral pathways must be in place for suspected reactivation of choroidal neovascularisation and rapid referral for second eye involvement. Practical considerations for intravitreal injection therapy are outlined.

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    Rights statement: This is the final published version of the article (version of record). It first appeared online via Springer Nature at https://doi.org/10.1038/s41433-018-0300-3 . Please refer to any applicable terms of use of the publisher.

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