The Effectiveness of Community vs. Hospital Eye Service follow-up for patients with neovascular age-related macular degeneration with quiescent disease: a virtual trial

ECHoES is a randomised controlled trial which will test whether retreatment decisions made by community optometrists for patients with ‘wet’ or neovascular form of age-related macular degeneration (nAMD) whose disease has been rendered quiescent by anti-VEGF drugs are as good as retreatment decisions made by hospital ophthalmologists.

Why is this trial being done and what is its importance to the NHS?

The present standard of care for patients with wet AMD is monthly observation with administration of an anti-VEGF drug into the eye when the disease is active. Although the need for monthly treatment diminishes over time and re-treatment intervals may be extended, monthly hospital checks remain the preferred method of monitoring to detect disease activity. If community optometrists are shown to have similar accuracy to ophthalmologists in making retreatment decisions, there would be a strong impetus to transfer the monitoring of patients with stable disease to a community setting. Such a move would free up clinic capacity and allow hospital clinicians to concentrate on monitoring and treating patients during the active phase of wet AMD.

Rather than carrying out a new trial we will use the eye images (colour fundus and ocular coherence tomography images) collected during a large UK based multicentre clinical trial (the IVAN trial) to assess the ability of ophthalmologists and optometrists to make decisions on lesion activity.

Who can get involved in the ECHOES trial?

Both health care professionals (ophthalmologists and optometrists) and members of the public (persons affected by nAMD or their carers) can take part in this trial. There are two different aspects of the trial - Part A is for health care professionals only and Part B is open to both health care professionals and members of the public.

Please note health care professional can only participate in one part of the trial.

Part A: Vignette Assessment

We want to recruit health care professionals to take part in assessing anonymised clinical vignettes consisting of retinal images and selected clinical information of patients with nAMD. Following a period of structured training, health care professionals who have enrolled into ECHoES will be asked to assess a sample of vignettes. Participants will be asked to make the decision about whether retreatment is required for each vignette. Their decisions will be compared with a reference standard.

If you are a HEATH CARE PROFESSIONAL interested in taking part in vignette assessment click here for further information

Please note that recruitment for optometrists is now closed.

Part B: Focus Groups

We want to recruit health care professionals and members of the public to take part in a discussion (focus group) about the acceptability of the shift from hospital to community based monitoring and the advantages and disadvantages of such a move. The group will be facilitated by researchers skilled in leading such discussions, the conversation will be audio-recorded, transcribed and analysed to distil relevant themes.

If you are a HEALTH CARE PROFESSIONAL interested in participating in a focus group click here for further information

If you are a MEMBER OF THE PUBLIC interested in participating in a focus group click here for further information


This trial has been funded by the National Institute for Health Research.

Participants will be compensated for their time (for more information see Expenses).

News Feed:

1st July 2013 - Trial is open for recruitment!

31st July 2013 - Recruitment for optometrists now closed.