The NOD Age-related macular degeneration (AMD) audit report is a significant milestone in benchmarking the delivery of AMD treatment in the UK, using data recorded as part of routine clinical care. It reflects the desire and willingness of ophthalmologists throughout the UK to quality assure the care they provide for many thousands of patients who have the rapidly progressive ‘wet’ form of AMD.
The audit provides understanding of the quality of care and outcomes of treatment for AMD patients, recommendations and next steps for the audit.
AMD is the biggest cause of sight loss in the UK, affecting more than 700,000 people, with 39,800 patients developing ‘wet’ AMD each year. At age 60 around one in every 200 people has AMD. However, by the age of 90 it affects one person in five. The number of people with AMD is expected to rise by an alarming 60% by 2035. As AMD is such a significant public health concern it is essential that the NHS has a thorough understanding of the quality of the care it is providing and how to improve outcomes to maintain patients’ quality of life needs.
Key Findings
- More than 90% of eyes retained stable vision at the end of the first year of treatment and avoided a ‘significant’ further decrease in vision.
- Almost 20% of eyes (1 in 5) experienced a ‘significant’ improvement in vision and more than 40% (4 in 10) had ‘good’ vision (close to driving standard) after the first year of treatment.
- ‘Good’ vision acuity was retained in most eyes with this level of vision at the start of treatment but eyes with ‘poor’ vision at the start of treatment rarely achieved ‘good’ vision. This highlights the importance of prompt referral, initial assessment diagnosis and treatment.
- The initial loading phase of 3 injections at monthly intervals was completed within 10 weeks in 65% of eyes.
- The most frequent number of injections per eye in the first year of treatment was 7 and almost 70% (7 in every 10) of injections were administered by trained staff who were not doctors, such as nurses or optometrists.
- Treatment appeared to be safe, with a low number of serious side-effects. For example, the risk of serious infection after an injection was around 1 in 4,500.
The NOD AMD Audit received data from 75 centres in England, Northern Ireland, Scotland Wales and Guernsey. Analysis involved 20,452 eyes from 18,362 patients starting treatment in 2020/21 at 63 centres.
Mr Martin McKibbin, Clinical Lead for the NOD AMD Audit, commented: ‘I am delighted that the first report of the NOD AMD Audit has been published. Clinical staff at all the participating sites want to provide good clinical care and the best outcomes for their patients. The data in the audit will provide the first opportunity to benchmark care processes and acuity outcomes with peers and identify if any improvements are needed’.
The report confirms that regular injections help to stabilise vision in most eyes and early diagnosis and treatment are vital to maintaining good vision after treatment. By identifying best practice and allowing organisations to compare their performance with others, the audit aims to improve the
outcomes for all patients having treatment for ‘wet’ AMD. The Annual Report includes recommendations for patients, care providers, commissioners and regulators as well as future steps to ensure the expansion of the NOD AMD audit remit.
Recommendations include
- Patients and carers whose local provider is not participating in the NOD AMD Audit, should encourage participation and request how local care pathways and outcomes compare to national benchmarks
- All providers of NHS-funded treatment for neovascular AMD are encouraged to demonstrate commitment to high quality care and good professional practice through participation in the NOD AMD Audit
- Providers should use the NOD AMD Audit for quality improvement, comparing peer local results against those regionally or national, acting on specific areas of improvement
- Service specification contracts should require quality assurance and improvement and submission of full data to the NOD AMD Audit
- Regulators should expect all providers of NHS-funded treatment to participate in all national audits with NOD Audit results made available to them when inspecting organisations
The NOD AMD Audit will continue to work with NHS Trusts and independent sector treatment providers to participate and improve the data quality for future audits.
Funding has been provided from Bayer, Novartis, Roche and the Macular Society to enable the National Ophthalmology AMD Audit.
You can read the NOD AMD Audit Full Annual Report 2023
There is a patient information leaflet explaining the key findings, read the NOD AMD Audit Patient Summary 2023 and Patient Summary report (Word version).