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    Community monitoring of nAMD as effective as hospital monitoring

    Community monitoring of neovascular age-related macular degeneration (nAMD) can be just as effective as hospital-based monitoring, researchers say.

    “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,” said Usha Chakravarthy of Queen’s University Belfast, UK, in a press release.

    Professor Chakravarthy and colleagues published their findings in BMJ Open

    After treatment, most patients in the UK are asked to visit hospital outpatient departments monthly for monitoring.

    But this may unnecessarily burden hospital eye services, the researchers write. It blocks clinic space, uses valuable resources, is expensive and is also burdensome to the patients and those who care for them. Some hospitals are struggling to provide clinic appointments at recommended intervals.

    With funding by the National Institute for Health Research (NIHR), Professor Chakravarthy and colleagues recruited ophthalmologists with experience in treating nAMD and optometrists not participating in nAMD care.

    To test whether optometrists could screen for reactivated nAMD, a randomised controlled trial might not work because patients might not trust optometrists to do this work, the researchers speculated. Also these trials are expensive and take a long time.

    To see how well community optometrists could review quiescent nAMD, the researchers provided a training webinar to 72 ophthalmologists and 83 optometrists.

    The trial was unusual in that it was based online, with eye doctors and optometrists making decisions based on vignettes rather than real patients.

    The researchers created 288 vignettes representing patients with quiescent nAMD being monitored for reactivation. Each vignette consisted of sets of colour fundus and OCT images from the study eye at two time points: ‘baseline’ from when the lesions were quiescent and ‘index’ from another clinical visit. The vignettes included clinical information such as visual acuity.

    Three retina specialists evaluated the vignettes and established a reference standard for each index image. In the 28% of cases where they did not agree, they met to reach a consensus.

    After participants took part in the webinars, the researchers asked them to assess 24 training vignettes each. If the participants could not correctly classify the lesion status for 18 of these vignettes, they were given a different set of 24 vignettes. If they could not correctly classify the lesion status of 18 of these vignettes, they were excluded from the trial.

    Study outcomes

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