AMD audit results highlight the increasing pressure on AMD services

AMD audit results highlight the increasing pressure on AMD services in the UK

The College of Ophthalmologists 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 – the proportion of patients receiving their first treatment within two weeks of referral has fallen from around 40% to 30% in the last year.

Introducing the audit report, the College’s former President, Professor Ben Burton, said: “Whilst we don’t know the reason for this reduction, I can’t help wondering if the hundreds of millions of pounds spent on reducing cataract waiting lists could have been better spent on making sure patients with treatable, irreversible causes of blindness get treatment on time.’’

The report’s focus is on patients starting treatment for wet AMD in one or both eyes in the 2023 NHS year (1 April 2023 to 31 March 2024). The audit analysed data from almost 29,000 eyes and more than 26,000 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 75 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 61% of those treated were women. Just under 32% of patients started treatment within 14 days of referral from primary care, and the initial 3 monthly injections during the loading phase of treatment was completed within 10 weeks in just over 66% 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 74% of injections were administered by trained staff who were not doctors, such as nurses or optometrists.
• 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 initiation.
• The risk of serious infection (presumed infectious endophthalmitis) was approximately one case per 5,000 injections, failing to meet the acceptable performance threshold of one case per 6,000 injections.
• Data on delayed follow-up visits was available for 46% of patients. Among those with available data, planned treatment was delayed by two weeks or more on at least two occasions in over half of patients.

You can see the full findings on the NOD website.