Trainee-led vs. specialist-led management of neovascular age-related macular degeneration.

Abstract

Purpose : To compare the outcomes of trainee-led and specialist-led management of neovascular Age-related Macular Degeneration (nAMD).

Methods : Prospective registry-based observational study. Treatment naïve eyes from two centres with both trainee-led and specialist-led nAMD management for a proportion of their patients were included, provided they had at least 12 months follow-up. The management and outcomes of patients receiving trainee-led care were compared to those receiving specialist-led care. The primary outcome was the mean change in visual acuity at 12 months from first injection. Secondary outcomes included the number of injections. Outcomes were also presented at 36 months where available.
Trainees were defined as doctors enrolled in a registered/accredited pathway towards specialist qualifications but who had not yet completed their training. Trainee-led patients were independently assessed and managed by trainees. Supervisors were available, however involvement in patient care only occurred at the request of the trainee. Trainees had at least 2 years of supervised clinical ophthalmology experience.
Specialists were fully trained ophthalmologists licenced to practice independently without supervision, and with retinal sub-specialty fellowship training. Specialist-led patients were those who’s treatment decisions were made by specialists, however the injections themselves could be administered by a specialist or a trainee.

Results : 726 eyes were included in the study, 534 receiving trainee-led treatment, and 192 specialist-led treatment. The adjusted change in acuity at 12 months in trainee-led vs. specialist-led eyes was +3.2 letters vs. +4.1 letters (P=0.473). This was achieved with a mean of 6.5 vs. 7.2 injections (P=0.260). 426 eyes had 36 month outcomes. In these eyes the mean adjusted change in acuity at 36 months was again similar for trainee and specialist managed eyes (-0.9 letters vs. +0.2 letters, P=0.596). Eyes treated by trainees received fewer injections on average to 36 months (15.0 vs. 19.0, P=0.004).

Conclusions : No significant differences in outcome between eyes managed by trainees and eyes managed by specialists were observed. Trainee-led management of nAMD is a reasonable approach where regulatory and practical considerations allow it.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.