Wet AMD

4) Guidance for referral for Wet AMD in Birmingham and Solihull

 

4.1 Background

 

Wet AMD is one of the leading causes of severe visual loss in the UK. It is an acute and aggressive condition. Early diagnosis and prompt treatment may prevent further visual loss and can sometimes even restore some of the vision already lost. This guidance outlines the procedures to follow in order to access assessment and fast track to a consultant as appropriate.

 

All the major general hospitals in Birmingham and Solihull now have rapid access wet AMD clinics supervised by Lucentis Coordinators these are:

 

Sandwell and West Birmingham Foundation Trust:

 

          Birmingham & Midland Eye Centre (BMEC) at City Hospital  Fax referrals to 0121 507 6726

 

University Hospitals Birmingham Foundation Trust:

 

          Queen Elizabeth Hospital (UHB) email referrals to wetARMD@uhb.nhs.uk using the electronic form which can be found under the "Forms" link

 

Heart of England Foundation Trust: Fax referrals to 0121 424 4464 stating which hospital the patient wishes to be seen at.

 

          Birmingham Heartlands Hospital

          Solihull Hospital

          Good Hope Hospital

 

4.2 Assess the risk factors

 

Older person, though not exclusively.

Hypertension and treatment for hypertension.

Cardiovascular disease.

          Raised cholesterol levels.

Caucasian with occasional Asian and very occasional African / Caribbean.

Female (Greater incidence because more susceptible and longer life expectancy).

          Family History.

 

It is important to take and record full history including medications.

4.3 Make an evaluation of the signs and symptoms

 

A patient reporting sudden central vision loss or distortion, clouding, a dark relative scotoma in central field when dark-adapted, flashing lights or hallucinatory forms should be checked for wet AMD

The VA may still be good especially if the lesion is para-foveal.

Your examination of the fundus under mydriasis should look for

          Grey-green lesion

          Sub-retinal fluid

          Haemorrhage usually sub retinal but may be pre retinal

          Drusen associated with haemorrhage

Some of these symptoms could indicate other retinal conditions such as a retinal tear. Always check all the fundus.

Undertake a full refraction and record the best VA

Assess and record distortion with an Amsler chart

 

4.4 Decide about the referral

 

Fast track if the vision is 6/96 or better

And the patient presents with symptoms of recent onset occurring within past few days/weeks/months

And the symptoms are affecting central vision

And you can see a retinal lesion at the fovea or within 1 disc diameter of the fovea, which would indicate the possibility of recent onset wet AMD (this may be very subtle)

 

If your patient does not meet the fast track criteria there may still need to be an assessment and you should use your judgement to refer in the usual way either to A&E or for an urgent outpatient appointment.

If your patient has dry AMD then you may decide not to refer and the patient may be helped with a LVA

 

4.5 Fax referrals to the fast track wet AMD Service Co-ordinators if all criteria are met

 

         BMEC   Fax 0121 507 6726

 

         UHB       Fax 0121 627 8789

 

         HEFT     Fax 0121 424 5648 (single referral centre for all 3 sites i.e. Birmingham Heartlands Hospital, Good Hope Hospital and Solihull Hospital)

 

WHEN REFERRING TO HEFT PLEASE ASK THE PATIENT FOR THEIR PREFERRED SITE (BHH, SOLIHULL or GOOD HOPE) AND ICLUDE THEIR CHOICE IN YOUR NOTES ON THE REFERRAL FORM.

 

The wet AMD service co-ordinators will contact your patient by telephone and be able to arrange for them to be seen by an appropriate person within a few days.