Sir,

We 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.