Quality-Assured Follow-up of Quiescent Neovascular Age -Related maculaR dEgeneration by Non-medical Practitioners (FENETRE)

Quality-Assured Follow-up of Quiescent Neovascular Age -Related maculaR dEgeneration by Non-medical Practitioners

Quality-Assured Follow-up of Quiescent Neovascular Age -Related maculaR dEgeneration by Non-medical Practitioners: a Randomised Controlled Trial

National Institute for Health Research, United Kingdom, Newcastle University, Cardiff University, City, University of London, King's College London, Manchester University NHS Foundation Trust, University Hospitals Bristol and Weston NHS Foundation Trust, York Teaching Hospitals NHS Foundation Trust, Leeds Teaching Hospital NHS Foundation Trust, Bradford Teaching Hospitals NHS Foundation Trust, University College, London

This is a prospective, randomised, multi-site clinical trial testing the non-inferiority of community optometry follow-up of participants with QnAMD over 12 months

Neovascular Age-Related Macular Degeneration (nAMD) is a common vision threatening condition affecting mainly patients over the age of 65. 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 patients. This study will recruit 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 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. The study 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. The study will involve several hospital eye clinics across the country and several community optometrist practices. Meetings will also be held with patients to discuss their priorities and needs when looking at how to set up the community based eye clinics. During meetings with patients in preparation for this research, they felt positively about the possibility to receive care closer to home.

All investigations are the same in both arms, but patients within this arm will be seen in the hospital as per standard practice.

All investigations are the same in both arms, but patients within this arm will be seen in a community optometrist practice.

The proportion of Participants who reactivate within 12 months of randomisation but are not identified as having re-activated (false negatives).

The proportion of Participants who reactivate within 12 months of randomisation but are not identified as having re-activated (false negatives).

Primary economic outcome: Incremental cost per quality adjusted life year (QALY) gained over the estimated patient lifetime estimated from an economic model informed by trial data.

Primary economic outcome: Incremental cost per quality adjusted life year (QALY) gained over the estimated patient lifetime estimated from an economic model informed by trial data.

Diagnostic accuracy of the intervention (community optometry follow up of QnAMD) against the reference standard (rate of false negatives and false positives)

Diagnostic accuracy of the intervention (community optometry follow up of QnAMD) against the reference standard (rate of false negatives and false positives)

Rate of over-referral (i.e. Reference Standard is quiescent but classification is 'reactivated' or 'suspicious')

Rate of over-referral (i.e. Reference Standard is quiescent but classification is 'reactivated' or 'suspicious')

Mean change in visual acuity (measured with habitual correction and pinhole) for in the Participants intervention and control groups

Mean change in visual acuity (measured with habitual correction and pinhole) for in the Participants intervention and control groups

Inclusion Criteria: Participants receiving treatment in nAMD injection clinics, who have reached the agreed definition of disease quiescence Informed consent Aged > 55 years Ability to perform study specific procedures Exclusion Criteria: Significant media opacities (cataract, vitreous opacities) that would not allow good quality fundus imaging. Diabetic retinopathy of severity worse than mild non-proliferative stage and with any degree of diabetic maculopathy History of other causes of Choroidal Neovascularisation (myopic, angioid streaks, inflammatory, retinal dystrophies, secondary to Central Serous Chorioretinopathy, idiopathic).

Learoyd AE, Tufail A, Bunce C, Keane PA, Kernohan A, Robinson E, Jaber A, Sadiq S, Harper R, Lawrenson J, Vale L, Waterman H, Douiri A, Balaskas K; FENETRE study group. FENETRE study: quality-assured follow-up of quiescent neovascular age-related macular degeneration by non-medical practitioners: study protocol and statistical analysis plan for a randomised controlled trial. BMJ Open. 2021 May 11;11(5):e049411. doi: 10.1136/bmjopen-2021-049411.