Ophthalmology Services Thematic Report published

We decided to undertake a review of ophthalmology services due to the concerns being highlighted across Wales relating to the waiting times being experienced by ophthalmology patients. 

Due to the risks associated with any delay in treatment for patients with ‘wet’ Age Related Macular Degeneration (AMD) this review focusses on the ‘wet’ AMD treatment pathway to understand the patient journey from referral to discharge.

The review looked across the boundaries of primary and secondary care to examine how providers were delivering and developing the care and support required by patients.

What is ‘wet’ AMD?

Wet AMD – sometimes called neovascular AMD – develops when abnormal blood vessels form underneath the macula and damage its cells. Without treatment, vision can deteriorate within days. The early diagnosis and treatment of wet AMD is essential for reducing the risk of severe vision loss.

What we found

• Eye care services across Wales have insufficient capacity in secondary care to meet current demands.
• Health Boards need better information about the demand capacity gap to enable informed workforce planning decision. 
• The absence of key personnel can cause parts of the care pathway to stop working effectively increasing the risk of potential avoidable harm to patients. 
• We saw some new initiatives across Wales relating to delivery of ‘wet’ AMD services, including the introduction of non-medical injectors, however progress in development and delivery of these initiatives has not been consistent across health boards.
• Health Boards understand that further development of services is required to fully utilise available resources to strengthen infrastructure and sustainability of eye care services. 
• Welsh Government have required that all health boards must establish and Eye Care Group and appoint an Optometric Advisor to work with colleagues in secondary care to improve working relationships and to facilitate initiatives to deliver more joined up services. 
• Public awareness of ‘wet’ AMD requires more attention. Too often ‘wet’ AMD is detected by a routine eye test by which vision may already be poor. Patients need to ensure they have regular eye tests. 

We have made 22 recommendations for Health Boards and policy makers to consider as result of these findings. Further information on our findings and our recommendations is available in the report below.