Quality statement 4: Monitoring late age-related macular degeneration (wet active)

Quality statement 4: Monitoring late age-related macular degeneration (wet active)

Quality statement

Adults with late age-related macular degeneration (AMD) (wet active) have monitoring for both eyes.

Rationale

Monitoring of late AMD (wet active) in both eyes is important for identifying changes that are associated with the condition. Monitoring supports treatment planning, which helps to avoid under-treatment, which could result in loss of vision, and over-treatment (unnecessary anti-VEGF injections), which could be associated with harm and affect quality of life. The interval between appointments should be determined by the healthcare professional responsible for planning the person's care.

Quality measures

Structure

Evidence of local arrangements to ensure that adults with late AMD (wet active) have monitoring for both eyes.

Data source: Local data collection, for example, service specifications and local protocols for monitoring appointments for adults with late AMD (wet active).

Process

a) Proportion of adults with late AMD (wet active) who have a monitoring appointment scheduled.

Numerator – the number in the denominator who have a monitoring appointment scheduled.

Denominator – the number of adults with late AMD (wet active).

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

b) Proportion of scheduled monitoring appointments for adults with late AMD (wet active) that are cancelled or delayed by the hospital.

Numerator – the number in the denominator that are cancelled or delayed by the hospital.

Denominator – the number of scheduled monitoring appointments for adults with late AMD (wet active).

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

c) Proportion of hospital appointments for adults with late AMD (wet active) that occur within 25% of their intended monitoring period, including rescheduling of hospital cancellations and non-attendance by adults with late AMD (wet active).

Numerator – the number in the denominator that occur within 25% of their intended monitoring period.

Denominator – the number of monitoring appointments scheduled, including those rescheduled after hospital-initiated cancellation and non-attendance by adults with late AMD (wet active).

Data source: Local data collection: Portfolio of Indicators for eye health and care – indicator 11 for the System and assurance framework for eye health (SAFE), which has been adopted as an outcome measure by NHS England Elective care transformation programme: Transforming elective care services: ophthalmology.

Outcome

Loss of vision (changes to visual acuity) in adults 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), percentage of eyes losing ≥3 LogMAR lines between baseline and month 12 (figure 8), visual acuity change from month 3 to month 12 (figure 10) and percentage of patients retaining visual acuity of 70 letters/LogMAR visual acuity of 0.3 or better (at 1 year; figure 11). 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.

What the quality statement means for different audiences

Service providers (NHS hospital trusts) ensure that they have agreed protocols for adults with late AMD (wet active) to have monitoring of both eyes at clinically appropriate intervals determined by the healthcare professional responsible for planning their care.

Healthcare professionals (such as ophthalmologists, advanced nurse practitioners, optometrists and orthoptists working in secondary care) monitor both eyes of adults with late AMD (wet active) at intervals determined by the healthcare professional responsible for planning their care.

Commissioners (clinical commissioning groups) ensure that services provide monitoring of both eyes for adults with late AMD (wet active) at intervals determined by the healthcare professional responsible for planning their care.

Adults with late AMD (wet active) have both their eyes monitored regularly so that treatment can be planned to preserve their sight and quality of life. The time between appointments is determined by the healthcare professional responsible for planning their care.

Source guidance

Age-related macular degeneration (2018) NICE guideline 82, recommendation 1.7.8