British Journal of Ophthalmology
August 2019

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

Rohan W Essex, Vuong Nguyen, Vincent Daien, Sarah Steinmann, Richard Walton, Mark C Gillies, Daniel Barthelmes


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.