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Peng Yong Sim, Sonul Gajree, Baljean Dhillon, Shyamanga Borooah; Identifying causes for delays from symptom onset to treatment in patients with wet age-related macular degeneration (AMD) in south-east Scotland. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1525. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Treatment delay in wet AMD is associated with reduced visual outcome. There have been many reports related to patient pathways and the time from referral to first intravitreal (IVT) treatment for patients with wet AMD. However, there is a dearth of literature reporting on non-clinical pathway factors and the time from symptom onset to first presentation at primary care. In this study, we assess the delay between the different stages of the wet AMD care pathway in south-east Scotland. We hypothesized that first presentation to primary care may also account for a significant delay and that this may result from a lack of AMD awareness.
Case notes of patients treated with IVT for wet AMD in south-east Scotland between 2013–2015 were analyzed. We measured 1) time from symptom onset to presentation at primary care, 2) time from referral to ophthalmic clinic appointment and 3) time from ophthalmic clinic appointment to first IVT treatment.To investigate AMD awareness, we performed a cluster random sample survey of patients visiting non-AMD ophthalmic clinics using a previously validated 12-item questionnaire. Demographic details (age, sex, education) were collated. Awareness of AMD and its risk factors were evaluated.
195 patients (61.5% female, mean age 78) were included in the study. The mean time from symptom onset to first presentation was 54.2 (95% CI±13) days. The mean delay for other stages of the wet AMD care pathway are shown in Figure 1. Notably, there was an additional mean delay of 7.5 (95% CI±1.6) days when patients were indirectly referred by optometrists via general practitioners (p<0.05).140 patients (79% female, mean age 78) participated in the awareness survey. 73 (52.1%) reported being “aware” of AMD but only 57 (40.7%) described AMD symptoms correctly. The top two risk factors identified correctly were age (127; 90.7%) and smoking (82; 58.6%) respectively.
There is significant delay at every step of the wet AMD patient pathway in south-east Scotland. However, we note a considerable delay from symptom onset to first presentation at primary care. Our findings suggest that suboptimal awareness of AMD symptoms could account for this delay. This highlights the need to increase awareness of AMD in order to optimise visual outcomes in patients.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
Fig 1. Breakdown of the total delay from symptom onset to treatment.
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