title: Clinical characteristics and selection of treatment modality for patients with vitreomacular traction: real-world implementation of NICE guidance (TA297).
abstract: OBJECTIVE
  To investigate the qualitative aspects in patient selection and the quantitative impact of disease burden in real world treatment of vitreomacular traction (VMT) and implementation of the National Institute for Health and Care Excellence (NICE) guidance (TA297).
  
  
  METHODS
  A monocentric, retrospective review of consecutive patients undergoing optical coherence tomography (OCT) imaging over a 3 month period. Patients with VMT in at least one eye were identified for further data collection on laterality, visual acuity, symptoms, presence of epiretinal membrane, macular hole and treatment selection.
  
  
  RESULTS
  A total of 3472 patients underwent OCT imaging with a total of 6878 eyes scanned. Out of 87 patients, 74 patients had unilateral VMT (38 right, 36 left) and 13 patients had bilateral VMT. Eighteen patients with unilateral VMT satisfied NICE criteria of severe sight problems in the affected eye. Eight were managed for a coexisting pathology, one refused treatment, one patient did not attend, two closed spontaneously, and one received ocriplasmin prior to the study start date. Only two patients with unilateral VMT received ocriplasmin and three underwent vitrectomy. Those failing to meet NICE criteria for unilateral VMT were predominantly asymptomatic (n=49) or had coexisting ERM (n=5) or both (n=2).
  
  
  CONCLUSIONS
  Ocriplasmin provides an alternative treatment for patients with symptomatic VMT. Our data shows that the majority of patients with VMT do not meet NICE TA297 primarily due to lack of symptoms. Those meeting NICE criteria, but not treated, tended to have coexisting macular pathology. Variation in patient selection due to subjective factors not outlined in NICE guidance suggests that real world outcomes of ocriplasmin therapy should be interpreted with caution.
authors.affiliation: Ophthalmology Department, Wolverhampton Eye Infirmary, New Cross Hospital, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, Birmingham, UK.
authors.forename: Edward William James
authors.initials: EW
authors.lastname: Pritchard
authors.affiliation: Ophthalmology Department, Wolverhampton Eye Infirmary, New Cross Hospital, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, Birmingham, UK.
authors.forename: Shams-Ulislam
authors.initials: SU
authors.lastname: Ilyas
authors.affiliation: College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Soha Khaled
authors.initials: SK
authors.lastname: Amar
authors.affiliation: Optometry Department, Faculty of Life and Health Sciences, Aston University, Birmingham, UK.
authors.forename: Yit Chuin
authors.initials: YC
authors.lastname: Yang
authors.affiliation: Ophthalmology Department, Wolverhampton Eye Infirmary, New Cross Hospital, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, Birmingham, UK.
authors.forename: Nirodhini
authors.initials: N
authors.lastname: Narendran
keywords: ocriplasmin; pharmacologic vitreolysis; posterior vitreous detachment; vitreomacular traction
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