title: Redesigning services for the management of vitreomacular traction and macular hole.
abstract: Vitreomacular traction (VMT) and VMT with macular hole (MH) are serious conditions, being associated with visual disturbance, for example, metamorphopsia, and diminished visual acuity (VA). Pars plana vitrectomy is the routine treatment for symptomatic VMT and VMT+MH. However, ocriplasmin has demonstrated favourable efficacy and safety in specific patient groups with VMT/MH and is now recommended as a treatment option for certain patients by the National Institute of Health and Care Excellence. This means that services for managing patients with VMT/MH may need to be revised, as patients can now potentially receive treatment earlier in the course of the disease. VMT triage clinics could provide a more efficient way of managing VMT/MH patients. Patient assessment should always include high-definition optical coherence tomography, as this is the most accurate means of assessing abnormalities in the vitreoretinal (VR) interface, and an accurate measurement of best-corrected VA. It has been proposed that patients with VMT+MH be managed as a routine 6-week referral, with the complete patient journey-from initial referral to treatment-taking no longer than 6 months. It is important that patients are entered onto VR surgical lists so that there is no delay if ocriplasmin treatment is unsuccessful. Patients will need appropriate counselling about the expected outcomes and possible side effects of ocriplasmin treatment. One-year follow-up data should be collected by treatment centres in order to evaluate the new VMT service.
authors.affiliation: Faculty of Medicine and Health Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK.
authors.forename: W
authors.initials: W
authors.lastname: Amoaku
authors.affiliation: Princess Alexandra Eye Pavilion, Edinburgh, UK.
authors.forename: P
authors.initials: P
authors.lastname: Cackett
authors.affiliation: Birmingham and Midlands Eye Centre and Sandwell General Hospital, Birmingham, UK.
authors.forename: A
authors.initials: A
authors.lastname: Tyagi
authors.affiliation: University Hospital of North Staffordshire, Stoke-on-Trent, UK.
authors.forename: U
authors.initials: U
authors.lastname: Mahmood
authors.affiliation: Wolverhampton Eye Infirmary, Wolverhampton, UK.
authors.forename: J
authors.initials: J
authors.lastname: Nosek
authors.affiliation: Gloucestershire Clinical Commissioning Group, Brockworth, UK.
authors.forename: G
authors.initials: G
authors.lastname: Mennie
authors.affiliation: BBR Optometry, Hereford, UK.
authors.forename: N
authors.initials: N
authors.lastname: Rumney
mesh_terms: D019091:Critical Pathways / Q000458:organization & administration; D003695:Delivery of Health Care / Q000458:organization & administration*; D019468:Disease Management; D005341:Fibrinolysin / Q000627:therapeutic use; D006801:Humans; D010446:Peptide Fragments / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D012167:Retinal Perforations / Q000175:diagnosis / Q000628:therapy; D014821:Vitrectomy / Q000379:methods; D020255:Vitreous Detachment / Q000175:diagnosis / Q000628:therapy
chemical_list: D010446:Peptide Fragments; C054561:microplasmin; D005341:Fibrinolysin