Utilisation of orthoptists to give intravitreal injections—a multidisciplinary approach

Abstract

Sir, Utilisation of orthoptists to give intravitreal injections-a multidisciplinary approachWe read with interest the study conducted by the Medical Retina Intravitreal (IVT) Service at Moorfields Eye Hospital reporting the use of nurses to give IVT injections, and wish to report the utilisation of orthoptists at Frimley Park Hospital (FPH) and Oxford Eye Hospital (OEH) to deliver injections as part of their macular services. 1 With the exponential growth in numbers of patients requiring IVT injections of antivascular endothelial growth factor (antiVEGF) agents for neovascular age-related macular degeneration (nAMD), and for macular oedema in diabetic retinopathy and retinal vein occlusions, there has been a massive increase in the required capacity for clinic appointments and IVT injections.The IVT Service at FPH utilises both orthoptists and nurses, and the orthoptist also is involved in the outpatient assessment and management of AMD cases. FPH adapted the Moorfields Nurse-Led IVT policy to include orthoptists after obtaining support from the British and Iris Orthoptic Society (BIOS), and then submitted the policy to their Trust and obtained local approvals.The Guidelines for AMD assessment and IVT policy are currently with the BIOS Professional Development Committee to obtain approval to roll out the training programme to all orthoptists and will be available on the BIOS Special Interest Group for Retinal Disease website.The OEH is currently training orthoptists based on the FPH model to carry out IVT injections, as well as work in the AMD clinic. Orthoptists and optometrists work alongside specialist medical staff in the clinics to assess and manage AMD.Both centres have significantly increased their capacity to see and assess patients. At FPH an orthoptist and three nurses are trained, and the OEH has both orthoptists and nurses in training. As this is a relatively new initiative, careful planning, a targeted training programme, specific operating procedures, continuous audit and quality assurance, with robust processes are all mandatory. In the current era, with increasing numbers of patients requiring assessment and IVT intervention, centres using a multidisciplinary approach can address this workload with appropriate training and support. FPH and OEH wish to highlight here the potential of utilising orthoptist AHPs for IVT and AMD clinical services. Conflict of interestGeeta Menon has attended the Ad boards for Novartis, Allergan, Bayer, Alcon, and Alimera. Research grants have been awarded by Novartis, Bayer, Allergan, and Alcon to Frimley Park Hospital. Mrs Menon has also received travel grants from Bayer and Novartis. Susan Downes has received honoraria in the past for lectures from Bayer and Novartis, and has been a prinicipal investigator on the trials for both Bayer and Novartis. Oxford Eye Hospital has received funding for research personnel and equipment and for educational meetings from Bayer and Novartis. The remaining authors declare no conflict of interest.

Action on neovascular age-related macular degeneration (nAMD): recommendations for management and service provision in the UK hospital eye service

“…Notwithstanding this, to address significant workload on ophthalmology clinics, allied healthcare professional (AHP)-led intravitreal injection clinics have been established by multiple HES centres. Ophthalmic nurse practitioners, hospital optometrists, technicians and orthoptists play an increasingly significant role in the delivery of routine retina care, with extended roles helping to expand service provision capacity [35–37]. Results show positive patient satisfaction with a nurse-led injection service, with little variation in patient experience when compared to a doctor-led service, and an acceptable safety profile [35, 38].…”

Indemnity for orthoptist-delivered intravitreal injections

“…However, in the letter from Mall et al, 1 there appeared to be no reference to medico-legal consultation on this new scope of professional practice for orthoptists.…”

“…We read with interest the article 'Fellow eye effect of unilateral intravitreal bevacizumab injection in eyes with diabetic macular edema'. 1 The authors report improvement in the non-injected eye of patients that received unilateral bevacizumab for diabetic macular oedema. A previous study also reported a significant difference in the mean macular thickness of the fellow eye treated with unilateral intravitreal bevacizumab for diabetic macular oedema, but no difference in the fellow eye of those receiving unilateral ranibizumab.…”

“…1 With the exponential growth in numbers of patients requiring IVT injections of antivascular endothelial growth factor (antiVEGF) agents for neovascular age-related macular degeneration (nAMD), and for macular oedema in diabetic retinopathy and retinal vein occlusions, there has been a massive increase in the required capacity for clinic appointments and IVT injections.…”

“…1 With the exponential growth in numbers of patients requiring IVT injections of antivascular endothelial growth factor (antiVEGF) agents for neovascular age-related macular degeneration (nAMD), and for macular oedema in diabetic retinopathy and retinal vein occlusions, there has been a massive increase in the required capacity for clinic appointments and IVT injections.The IVT Service at FPH utilises both orthoptists and nurses, and the orthoptist also is involved in the outpatient assessment and management of AMD cases. FPH adapted the Moorfields Nurse-Led IVT policy to include orthoptists after obtaining support from the British and Iris Orthoptic Society (BIOS), and then submitted the policy to their Trust and obtained local approvals.…”