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

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.