Quality statement 3: Treatment – late age-related macular degeneration (wet active)

Quality statement 3: Treatment – late age-related macular degeneration (wet active)

Quality statement

Adults with late age-related macular degeneration (AMD) (wet active) start treatment within 14 days of referral to the macular service.

Rationale

Late AMD (wet active) can deteriorate rapidly. Any delay to starting treatment may lead to a worsening of outcomes over the long term. Minimising delays in starting treatment increases the chances of preserving vision and so quality of life.

Quality measures

Structure

Evidence of local arrangements and clinical protocols to ensure that adults with late AMD (wet active) start treatment within 14 days of referral to the macular service.

Data source: Local data collection, for example, referral pathways.

Process

Proportion of adults with late AMD (wet active) who start treatment within 14 days of referral to the macular service.

Numerator – the number in the denominator who start treatment within 14 days.

Denominator – the number of adults with late AMD (wet active) referred to the macular service.

Data source: Local data collection, for example, patient records, referral records and appointment systems.

Outcomes

a) Loss of vision (changes to visual acuity) of people with late AMD (wet active).

Data source: Database audit – National Electronic AMD Audit feasibility report contains: mean change in visual acuity between baseline and month 12 (figure 7) and percentage of eyes losing ≥3 LogMAR lines between baseline and month 12 (figure 8). Data, collected from 40 centres dating from January 2012 to December 2013 (8 had low numbers and the data were excluded) were last collected in 2016. Available from the National Ophthalmology Database Audit.

b) Health-related quality of life of adults with late AMD (wet active).

Data source: Local data collection, for example, a questionnaire.

What the quality statement means for different audiences

Service providers (NHS hospital trusts) have agreed protocols to ensure that adults with late AMD (wet active) start treatment within 14 days of referral to the macular service.

Healthcare professionals (such as ophthalmologists, advanced nurse practitioners, optometrists and orthoptists working in secondary care) treating late AMD (wet active) in adults adhere to local protocols and start treatment within 14 days of referral to the macular service.

Commissioners (clinical commissioning groups) monitor providers to ensure that treatment for adults with late AMD (wet active) starts within 14 days of referral to the macular service.

Adults with late AMD (wet active) start their treatment within 14 days of being referred to the specialist service so that they have the best possible chance of keeping their sight.

Source guidance

Age-related macular degeneration (2018) NICE guideline 82, recommendation 1.4.10