Sanders Francis W B, John Rebecca, Jones Philip, Williams Gwyn Samuel
Department of Ophthalmology, Singleton Hospital, Swansea, UK.
Primary Care Services, NHS Wales Shared Services Partnership, Cardiff, UK.
Clin Optom (Auckl). 2024 Nov 13;16:293-299. doi: 10.2147/OPTO.S470577. eCollection 2024.
The prevalence of neovascular age-related macular degeneration (nAMD) continues to increase. Hospital Eye Services are operating above capacity, innovative solutions to minimise the high proportion of false negative referrals, improve the care pathway and increase capacity for those patients who need ongoing care are essential are essential.
A two-phase retrospective longitudinal analysis of all patients referred and assessed for nAMD between; April 2019 to March 2020 (Phase 1) n=394, and April 2020 to March 2021 (Phase 2) n= 414, within Swansea Bay University Health Board (SBUHB). All patients with suspect nAMD were referred to the hospital based nAMD clinic in phase 1, and a community optometry nAMD decision making pathway in phase 2. All clinical records were reviewed, and data collated for subsequent analysis. Age, sex, date of referral, diagnosis, and treatment date were all recorded and analysed.
During phase 1, 104 new nAMD cases needing treatment were diagnosed with 85% (n=88) receiving treatment within 2 weeks of initial referral. During phase 2, 230 new nAMD cases requiring treatment were diagnosed with 94% (n=216) receiving treatment within 2 weeks of initial referral. Both the proportion of nAMD cases diagnosed (χ² = 70.8; p<0.001) and proportion of those treated within 2 weeks of initial diagnosis (χ² = 7.57; p<0.05) were significantly higher during phase 2.
There are advantages to a community optometry nAMD decision-making pathway with regard to 1) decreasing the number of patients requiring HES attendance, 2) increasing the number of patients able to access treatment for nAMD within 2 weeks of initial referral 3) an increased rate of diagnosis confirmation of nAMD and 4) a decrease in the rate of false-positive referrals.
新生血管性年龄相关性黄斑变性（nAMD）的患病率持续上升。医院眼科服务不堪重负，因此，采取创新解决方案以尽量减少高比例的假阴性转诊、改善护理路径并增加需要持续护理患者的服务能力至关重要。
对斯旺西湾大学健康委员会（SBUHB）在2019年4月至2020年3月（第1阶段）n = 394例，以及2020年4月至2021年3月（第2阶段）n = 414例期间转诊并接受nAMD评估的所有患者进行两阶段回顾性纵向分析。在第1阶段，所有疑似nAMD患者均被转诊至医院的nAMD诊所，在第2阶段则采用社区验光nAMD决策路径。审查所有临床记录，并整理数据以供后续分析。记录并分析年龄、性别、转诊日期、诊断和治疗日期。
在第1阶段，诊断出104例需要治疗的新nAMD病例，其中85%（n = 88）在初次转诊后2周内接受了治疗。在第2阶段，诊断出230例需要治疗的新nAMD病例，其中94%（n = 216）在初次转诊后2周内接受了治疗。第2阶段nAMD病例的诊断比例（χ² = 70.8；p<0.001）和初次诊断后2周内接受治疗的比例（χ² = 7.57；p<0.05）均显著更高。
社区验光nAMD决策路径具有以下优势：1）减少需要到医院眼科服务就诊的患者数量；2）增加初次转诊后2周内能够接受nAMD治疗的患者数量；3）提高nAMD诊断确认率；4）降低假阳性转诊率。
