Quality-Assured Follow up of quiEscent Neovascular agE-relaTed maculaR dEgeneration by non-medical practitioners: a randomised controlled trial The FENETRE study

Neovascular Age-Related Macular Degeneration (nAMD) is a common vision threatening condition affecting mainly patients over the age of 65. Effective treatments exist but require monthly visits to hospital eye clinics for tests and eye injections for a period often of several years. At some point during follow-up the disease becomes inactive in many cases and does not need more injections. The risk of a flare-up is high, however, and patients need to continue to be seen every month for a significant period of time. Hospital-based eye clinics are struggling to cope with current and expected workload for assessing and treating patients with nAMD. Transferring care of these patients to the community closer to home would ease the workload for hospital based clinics and offer a better experience of care to our patients. Previous research showed that non-medical practitioners (optometrists) can be trained to follow-up patients with nAMD when this has become inactive. More research is needed however to show with certainty that providing care for these patients in the community by trained optometrists is safe, well-received by patients and beneficial to the NHS in terms of costs. In this study we will involve 742 patients with nAMD who have reached this inactive phase of the disease. Half of the patients that want to take part will continue to have their follow-up appointments, to make sure their disease is quiet, in the hospital eye clinics as usual. The other half, chosen by chance, will have follow-up visits every month in a community optometrist practice by trained optometrists. The research team will provide the training for community optometrists. The study will seek to show that the community based care is no less safe than hospital-based care. We will also check what is the impact of this different way of offering care on the NHS budget and how the patients and practitioners perceive this. We will involve several hospital eye clinics across the country and several community optometrist practices. We will also hold meetings with patients to discuss their priorities and needs when looking at how to set up the community based eye clinics. During meetings we had with patients in preparation for this research, they felt positively about the possibility to receive care closer to home. Throughout the course of this research we will be consulting our patients on issues arising during the course of the study and will rely on their opinions for interpretation of final results as well as help in preparation of materials to patients, public and practitioners. This research is important because it may show that community based care from non-medical practitioners can be safe and well-received by our patients, removing some of the excessive workload from hospital eye clinics and freeing up more space for patients with active disease to be seen and have treatment. Our patients with inactive disease will be able to be seen in a more convenient way closer to home with less time spent travelling. We will make the results of our research widely available to the NHS, optometry groups and our patients to ensure there is clear understanding of the evidence to support any potential new model of care in the community for our patients with nAMD.