An Evaluation of the Emergency Macular Assessment Clinic (EMAC): Referral, Diagnosis and Treatment Outcomes

Abstract

As the burden on Hospital Eye Services in the government sector continues to escalate, due to an ageing population and a shortfall in ophthalmologists’ numbers, optometrists are becoming increasingly involved in diagnosis and management of patients with macular disease. Virtual clinics have been introduced as means of alleviating this burden. This thesis evaluates a virtual clinic, Emergency Macular Assessment Clinic (EMAC) at Manchester Royal Eye Hospital (MREH) by examining referral patterns to the service, management outcomes of referred macular conditions, and the impact of socioeconomic factors on these patterns. Agreement between secondary care optometrists with specialist interest (OSIs) and ophthalmologists for incoming referrals to the service was also analysed. The impact of further education and training on optometrists’ confidence levels and diagnostic performance was evaluated. In-depth analyses of referrals to EMAC over a three-month period (August to October 2019) were performed to address the aforesaid objectives. The efficacy of additional training was examined through two surveys and delivery of an interactive workshop. Demographics of conditions referred to EMAC were mostly in line with pre-existing literature. Age-related macular degeneration (AMD) accounted for nearly half of referrals. About 94% of patients with wet AMD were treated within 2 weeks of referral and achieved visual gains comparable to current studies. EMAC OSIs and ophthalmologists had near perfect agreement in diagnosis and management of AMD and agreement of 92.7% for all other macular disorders. Health deprivation significantly impacts referral patterns and presentation onset of macular disease. Further education has a significant positive impact on optometrists’ confidence levels in assessing OCT and their overall diagnostic performance. Findings of the studies performed will help streamline the EMAC service, encourage training of more OSIs, and implementation of regular educational events for optometrists.