Macular Service Provision
Miss Clara McAvoy
Consultant Ophthalmologist
Wet AMD- rapid decrease in
vision and sudden onset
Treatment Burden

Photodynamic therapy:

135 patients per million of population.
3 monthly review.

Anti-VEGF:



450 patients per million of the population.
monthly review.
Service Demand
2009/2010
Number of Referrals
September
97
October
89
November
83
December
57
January
53
February
90
Total
469
Management



Consultant Ophthalmologist.
Fast track clinic-ophthalmological examination
fluorescein angiography
OCT
Diagnosis established- discharged/macular
degeneration clinic or medical retina clinic/ clinical
trial.
Pathway through the
Clinic
Clerical Staff
Nurse
Coding
Secretary
Patients
ECLO
Optometrist
Photographer
Doctor
Patient care patway
LIViT service: managing capacity
Patient
recruitment
External
Optom
GP
Admin
Assess/
Treatment
ETDRS
1st check
Assess/
Treatment
Phone
consultation
OCT
Appointment
ETDRS
ETDRS
OCT
Patient Info
Consent
V
I
R
T
U
A
L
IOP
Consent
INJECTION
reconfirm
Consent
INJECTION
And/ or
FFA
Slit lamp
Gen. Clinics
Treatment
clinics
Assess
OCT
Emergency
FFA clinic
ETDRS
Assess/
Treatment
Funding
OCT
Retina
Clinics
Fghanchi/2010
Slit lamp
Clinic Visit
SOS
reconfirm
Consent
INJECTION
Slit lamp
Colour
Photos
Slit lamp
reconfirm
Consent
INJECTION
C
L
I
N
I
C
Follow up
Assessmt
clinic
Capacity- Potential Solutions

Treatment of Macular degeneration by non-retinal
specialists.

Intravitreal injections by trained technicians/ nurses.

Follow- up clinics in community by optometrists.

Clinical assessments by trained optometrists/ nurses
under supervision of retinal specialist.
Other Considerations

Newer treatments

Newer indications

Cost

Audit
Summary



Consultant Lead.
Hospital Optometrists and experienced
imaging technicians.
Audit.
Thank you for your attention