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Trainee-led versus specialist-led management of neovascular age-related macular degeneration: a registry-based study

Abstract : OBJECTIVE: To compare the outcomes of trainee-led and specialist-led management of neovascular age-related macular degeneration. DESIGN: Prospective multicentre registry-based observational study. SETTING: Ophthalmology training centres in Australia and Europe where both trainee-led and specialist-led models of care coexist. PARTICIPANTS: Treatment-naïve eyes with neovascular age-related macular degeneration and at least 12 months follow-up. 726 eyes were included in the study from two centres, 534 receiving trainee-led treatment and 192 specialist-led treatment. INTERVENTIONS: The management and outcomes of patients receiving trainee-led care were compared with those receiving specialist-led care. MAIN OUTCOMES MEASURES: The primary outcome was the mean change in visual acuity at 12 months from first injection. Outcomes were also presented at 36 months where available. RESULTS: The mean age of participants was 79 years and 65% were female. The adjusted change in acuity at 12 months in trainee-led vs specialist-led eyes was +3.2 letters vs +4.1 letters (difference -0.9 letters, 95% CI -3.4 to 1.5, p=0.473). The mean adjusted change in acuity at 36 months was -0.9 letters in trainees vs +0.2 letters for specialists (difference -1.1 letters, 95% CI -5.1 to 2.9, p=0.596). Eyes treated by trainees received fewer injections on average to 36 months (15.0 vs 19.0, p=0.004), although this trend was observed at one centre only. CONCLUSIONS: No significant differences in outcome between eyes managed by trainees and eyes managed by specialists were observed. Appropriately structured trainee-led management of neovascular age-related macular degeneration is a reasonable approach where regulatory and practical considerations allow it.
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https://hal.umontpellier.fr/hal-02563385
Contributeur : Amandine Michel-Avella <>
Soumis le : mardi 5 mai 2020 - 12:03:19
Dernière modification le : vendredi 15 mai 2020 - 12:22:09

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Rohan Essex, Vuong Nguyen, Vincent Daien, Sarah Steinmann, Richard Walton, et al.. Trainee-led versus specialist-led management of neovascular age-related macular degeneration: a registry-based study. British Journal of Ophthalmology, BMJ Publishing Group, 2019, 103 (8), pp.1158-1162. ⟨10.1136/bjophthalmol-2018-311852⟩. ⟨hal-02563385⟩

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