East Kent Wet Age-Related Macular Degeneration Service

Descriptions

Background: NICE Technology Appraisals (TA) for the use of intravitreally injected medication have had a significant impact on the treatment of macular disease associated with the development of choroidal neovascularisation (CNV). These conditions are Wet Age-related Macular Degeneration (WAMD) and Myopic Degeneration with CNV (Myopia CNV). Not only have these previously untreatable or poorly responsive disease states now become amenable to treatment but they also now require lifelong monitoring. NICE have approved the use of both Ranibizumab and Aflibercept for treating WAMD and Ranibizumab for treating Myopia CNV Currently all treatment and monitoring of these 2 macular conditions is delivered by acute services, all patients experiencing symptoms or signs of either of condition are required to attend an acute service site for assessment and initiation of a loading dose of 3 intravitreal injections each one month apart. Subsequently every 4-5 weeks they must re-attend for monitoring and decision as to whether they require further injections. If an injection is deemed necessary they must attend the acute site for this – if not they continue to re-attend the acute site every 4-5 weeks for further monitoring indefinitely. However it has been demonstrated that there is now potential to safely repatriate these patients back to receive treatment and monitoring in primary/community care through appropriate commissioning. This will allow already overburdened acute services to concentrate on treating the other more complex indications for intravitreal therapy such as macular oedema due to diabetes or retinal vein occlusion as well providing a more cost-effective service closer to home for patients. Requirements: To provide a Consultant Ophthalmologist led service for the diagnosis, treatment and monitoring of WAMD and Myopia CNV. It should be delivered at sites distributed throughout East Kent in locations convenient for patients and utilizing the skill set of local Ophthalmologists, Optometrists, General Practitioners with a Special Interest,(GPwSI) Nurses, Eye Care Liaison Officer (ECLO) and Ophthalmic Technicians. The service must comply with relevant National Institute for Health and Care Excellence (NICE) and Royal College of Ophthalmology (RCO) Guidelines. As new drugs become available the service can utilize these following NICE guidance or Commissioner directive. The new pathway is expected to follow a community-based two-tier system, with providers designated as Tier 1 or 2 dependent on level of involvement in the pathway. The role of each Tier is as follows: Tier 1 : New Patients - Patient assessment and treatment initiation Tier 2 : Follow-up Patients - Monitoring and treatment continuation Providers will provide Tier 1 or Tier 2 only or both. Providers must make an Eye Care Liaison Officer (ECLO) available to patients at the point of care.