New Guidance for Commissioning Age Related Macular Degeneration Services
21 July 2021
The Royal College of Ophthalmologists (RCOphth) has developed Age Related Macular Degeneration Commissioning Guidance June 2021. The National Institute for Health and Care Excellence (NICE) has accredited the process used by The Royal College of Ophthalmologists to develop this guidance. It sets out the principles and minimum standards of care for AMD to decrease variations of care across AMD services in England and Wales.
The guidance can support the current and future capacity planning of AMD services to enable:
- the review of services, treatment options and patient pathways to meet the changing needs of the population
- local adaptation based on available resource, existing infrastructure, and service demands.
Sobha Sivaprasad, Chair of the Commissioning Guidance Development Group, and Chair of the RCOphth Scientific Committee explains, ‘This guidance will be of practical use for commissioners and providers of health and social care services, as well as users of AMD services. It is estimated that AMD affects more than 600,000 people in the UK1 and is the most common cause of visual impairment in the older population. It can significantly affect quality of life and independence. The demand for AMD services has already affected the capacity of several ophthalmology departments and is projected to rise as the ageing population increases.’
Commissioning AMD Services
The current and emerging Integrated Care Systems in England, with health and care services working closer together, will enable AMD services to work closely with system partners including council and community services. The cost improvement opportunities described in this new guidance can free up valuable resource which can then be reinvested back into services. The cost of providing AMD services is high due to the drugs involved and the impact on capacity within the hospital eye service as patients require frequent visits over several years. New and existing drugs are being evaluated to reduce the burden and improve outcomes. Advanced forms of AMD patients may also require additional social services, including low visual aids, counselling on coping with their loss of vision, and advice on available support.
This new guidance states that a patient focused approach should be the overarching principle when designing local pathways and that Eye Clinic Liaison Officers (ECLOs) are essential throughout a patient journey. It is also important to establish joint care with optometry services for diagnosis, referral, and monitoring of stable patients. There are new ways of delivering care which can be considered, such as telemedicine, clinical decision tools incorporating artificial intelligence and diagnostic hubs and treatment centres which can benefit patients, NHS, and wider society.
Age related macular degeneration (AMD) is a chronic progressive degenerative disease of the macula (centre of the retina) typically affecting people over the age of 50 years. There are two types of advanced forms of the disease, commonly called dry and wet AMD. The dry form is a slowly deteriorating condition with no treatment at present. The wet form presents acutely and needs both urgent and chronic treatment over years. Most patients with AMD are elderly. Many also have other chronic diseases and mobility issues, leading to greater risk of falls. Therefore, transport needs should be considered, and services should be readily accessible in terms of location, parking, public transport, and hours of opening. Stable treated AMD patients may be evaluated in the community.
Read The Guidance
Guidance for Commissioning Age related macular degeneration (AMD) services is available to download AMD Commissioning Guidance Full June 2021 and the AMD Commissioning Guidance Executive Summary June 2021
The guidance follows the RCOphth guidance development process and is based on best available evidence obtained from systematic review of the literature (see appendix A in the main document) and is compliant with the National Institute for Health and Care Excellence (NICE) Clinical Guideline on AMD NG82 dated 23-01-2018. NICE quality standard QS180 2021/PROF/433 5 (standards 3 and 4) dated February 2019 has also been considered in compiling this statement.
1 Estimate by The Macular Society
Useful links: The Way Forward – Age related macular degeneration