The College is calling on all providers of NHS-funded age-related macular degeneration (AMD) treatment to ensure all their patients start being treated within 14 days of referral to give them the best possible outcome.
Results from the latest National Ophthalmology Audit (NOD) age-related macular degeneration (AMD) audit report, published this week, show that – disappointingly – only 40% of patients started treatment within two weeks.
College President Professor Ben Burton said: “This is not good enough. We have repeatedly warned policymakers that more must be done to ensure support is there for those at most risk of irreversible sight loss.”
The report’s focus is on patients starting treatment for wet AMD in one or both eyes in the 2022 NHS year (1 April 2022 to 31 March 2023). The audit analysed data from more than 25,500 eyes and almost 23,500 patients starting treatment during the period.
All providers of NHS-funded AMD treatment were invited to take part and to submit routinely collected healthcare data for analysis. Results after the first year of treatment were available from 73 centres in England, Northern Ireland, Scotland, Wales and Guernsey.
Key findings from this year’s audit include:
- The average age when treatment was started was over 80 years and 60% of those treated were women. Just over 40% of people started treatment within a month of referral from primary care and the initial 3 monthly injections during the loading phase of treatment was completed within 10 weeks in 65% of eyes.
- The most frequent number of injections per eye in the first year of treatment was seven and the median interval between injections at the end of the first year was 10 weeks. More than 70% of injections were administered by trained staff who were not doctors, such as nurses or optometrists.
- Changes in vision at the end of the first year of treatment were like those found in the prior annual reports. More than 90% of eyes retained stable vision at the end of the first year of treatment and avoided a “significant” further decrease in vision. Almost 20% of eyes experienced a “significant” improvement in vision and more than 40% had “good” vision (close to driving standard) after the first year of treatment.
- The best outcomes were observed in eyes with better vision at the start of treatment, in younger people and in second treated eyes. “Good” vision was retained in most eyes with this level of vision at the start of treatment but eyes with “poor” vision at the start of treatment rarely achieved “good” vision after one year of treatment. These findings reinforce the importance of prompt referral, initial assessment, diagnosis and treatment.
- Treatment appeared to be safe, with a low number of serious side-effects. For example, the risk of serious infection after each injection was around 1 in 6,600.
- Follow-up data was unavailable for almost 20% of patients (2 in 10) after 12 months of treatment and for almost 40% (4 in 10) after 24 months. Visual outcomes after the first year of treatment were largely maintained in the second year. The most frequent number of injections per eye in the second year of treatment was 2.
You can see the full findings here.
Clinical lead Martin McKibbin said: “More centres have taken part in this year’s audit, and I strongly encourage others to participate. The audit enables providers to compare local outcomes of treatment, considering differences in baseline characteristics, and to identify the key clinical care processes. It is helping to identify best practice and, where necessary, redesign local care pathways. It has already shown the importance of starting treatment quickly, when vision is still good, and of completing the initial phase of monthly treatment promptly.”
To find out how to take part in the AMD audit and benefit from the collective insights, visit Audit participation and access | NOD Audit.