Information for Ophthalmologists and Optometrists

(Participant information leaflet v2.0 19th June 2013)

What is the purpose of the study?

The purpose of the ECHoES trial is to test whether retreatment decisions made by community optometrists for patients with the 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.

What is the rationale to the study?

The 'wet' or neovascular form of age-related macular degeneration (nAMD) is currently treated with drugs called anti-VEGF drugs. The drug is injected into the jelly-like substance inside the eye (vitreous). Injections are given monthly, if necessary, until the disease process is controlled. Anti-VEGF drugs successfully control the disease in about 90% of affected people.

Clinicians continue to observe patients monthly, even when no injections are needed, because there is a very high risk of needing to restart treatment at some point in the future. One of two strategies are typically used: (a) continue to review patients monthly until active disease recurs and then restart treatment or (b) give treatment even if the disease appears to be inactive but review patients less frequently. The former is very burdensome for patients and the latter leads to over treatment with its associated risks and additional expense to the NHS. If monitoring of the need for retreatment by community optometrists could be shown to have similar accuracy compared to monitoring of the need for retreatment by ophthalmologists in hospitals, there would be a strong impetus to devolve the monitoring of patients whose disease is inactive to the community setting.

Similar shared-care programmes exist for other eye diseases. Community optometrists would need to be able to take good quality pictures of the affected areas of the eye and assess the need for retreatment from these pictures and the clinical examination. They would then refer patients judged to require retreatment back to the hospital. Devolving monitoring to community optometrists would free up clinic capacity in the hospital and allow ophthalmologists to concentrate on monitoring and treating patients during the active phase of wet AMD, which has to be done in the hospital.