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Age-related Macular Degeneration

Age-related Macular Degeneration (AMD) is a long term condition which is the leading cause of sight loss in the UK. Sight loss often occurs quickly with the exudative (“wet”) form of AMD but can be stabilised or improved in most cases with prompt treatment and timely monitoring. The main objective for an AMD service is to minimise preventable sight loss.  Commissioning better eye care: Age-related macular degeneration from The College of Optometrists and The Royal College of Ophthalmologists is to help those designing and commissioning eye care to improve the value of their services.

About 10% of patients with AMD have the neovascular (“wet”) form of the condition which, untreated, often results in a rapid decline in visual acuity. Treatment consists of injections of an antibody to Vascular Endothelial Growth Factor (VEGF) into the vitreous cavity of the eye, usually at monthly intervals until the condition stabilises. There has been much debate about the high cost of ranibizumab, the drug approved by NICE for the treatment of neovascular AMD and whether bevacizumab, a less expensive drug which is not licensed for this use can be regarded as equivalent.

A College Statement Choice of anti VEGF agents for wet AMD treatments on this subject summarises the current position. It is also important to note that the costs of administration of appointments, diagnosis, monitoring and delivering the injections form a significant proportion of the total cost of the service. Many units have developed very efficient, high-throughput services where imaging, assessment of images by senior ophthalmologists and delivery of the injection (where required) are carried out at the same appointment.   Nevertheless, most areas of the country report difficulties in keeping pace with demand because many patients require multiple injections.

The College has released a statement Intra-ocular injections by non-medical health care professionals in response to the pressure that eye departments are under to deliver this treatment to thousands of new and follow-up patients.

Documents:

Royal_College_calls_for_review_of_bevacizumab_to_treat_AMD_191114

2013-SCI-318_RCOphth_AMD_Guidelines_Sept_2013_FINAL__2_

Commissioning better eye care: Age-related macular degeneration

Choice of anti VEGF agents for wet AMD treatments

Maximising Capacity in AMD Services

New to follow up ratios in ophthalmology outpatient services

Quality Assurance Self Test for AMD Services

Intra-ocular injections by non-medical health care professionals

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