Moorfields Eye Hospital NHS Foundation Trust is an NHS foundation trust which runs Moorfields Eye Hospital.The Trust employs over 1,700 people. Over 24,000 ophthalmic operations are carried out and over 300,000 patients are seen by the hospital each year. The trust delivers its services from its main site on City Road and through its distributed network of over 20 other 'satellite' clinics located in other parts of London and the South East including Ealing, Teddington, Tooting, Mile End, Harrow and Tottenham. Backing up NHS Direct, Moorfields has a specialised ophthalmic telephone advice line, Moorfields Direct.Moorfields was one of the first NHS foundation trusts, and is a founder member of the UCLPartners, an academic health science centre.It plans to move its main hospital from the current City Road site to St Pancras Hospital in Camden. This will cost £352 million and it is planned to be operational in 2025–26.
Vision impairment is increasingly recognised as a complex condition shaped not only by ocular pathology but also by cognitive, psychological, social and environmental factors that influence participation and quality of life. In line with the United Nations Convention on the Rights of Persons with Disabilities and the International Classification of Functioning, Disability and Health, contemporary vision rehabilitation frameworks adopt a biopsychosocial perspective that extends beyond treatment of the eye condition alone toward holistic support to improve the lives of individuals with vision loss. An overview of the effectiveness and future directions of multidisciplinary vision rehabilitation in clinical practice is presented, and a summary of the findings concerning the international standards of vision rehabilitation, focusing on adults. Furthermore, some examples of achievements in emerging fields are presented, such as neuroplasticity and visual system recovery, technological interventions and psychosocial support, including their future directions. Multidisciplinary models are widely supported but remain difficult to implement because of limited resources, workforce constraints and differences in culture and health policy. Overcoming these barriers is critical to expanding and strengthening multidisciplinary vision rehabilitation. The evidence highlights the need for implementation-focused research, closer collaboration across disciplines and core outcome measures that capture participation, mental health and quality of life, not just impairment. The overview also points to the importance of structured models that integrate neurorehabilitation (artificial intelligence-based) technology and mental healthcare while adapting to regional and cultural contexts. Embedding multidisciplinary vision rehabilitation within health systems is both a clinical necessity and a prerequisite for advancing global commitments to inclusion and equity for people with vision impairment. As population ageing and global demographic change are expected to increase the absolute numbers of adults with vision loss, strengthening collaboration between research, clinical practice and service delivery will be essential to further improve the quality of life of individuals with vision loss.
Objectives This process evaluation explores patient and healthcare professional acceptability of community-based monitoring versus hospital-based care for patients with quiescent neovascular age-related macular degeneration (QnAMD).Design Qualitative process evaluation was conducted as part of a randomised controlled trial.Setting Six hospitals and six community-based practices.Participants 25 patients and 16 healthcare professionals (ophthalmologists and optometrists). This approach helped differentiate between common issues and those specific to community-based monitoring.Intervention The Quality-Assured Follow-Up of QnAMD by non-medical practitioners trial aimed to examine whether non-medical practitioners follow-up patients with QnAMD in the community in a safe and clinically and cost-effective way. The process evaluation aimed to examine whether the intervention was acceptable by patients and professionals. The process evaluation was based on interviews which contained open-ended questions focused on patient experience and confidence in community-based care, issues concerning the practicalities of the organisation and management of the clinic, and resources including IT and digital equipment. The theory of acceptability framework was used to interpret the findings.Results Patients reported positively on the experience of receiving QnAMD services in the community and highlighted staff professionalism and clear communication. Key themes were the proximity of care provision for patients, IT interoperability and the real-world costs of running the service. Some patients randomised to the hospital showed preference for the intervention to take place in the hospital, mediated mainly by prior experience of hospital care and travel distance. The location of the clinic and transport routes affected the experience of attending appointments, with strong preference expressed for proximity to one’s home. Inaccessibility due to non-modifiable internal building structures in the community and parking in hospital eye services was reported by a small proportion of patients. Healthcare professionals reported positively about their ability to deliver QnAMD services in community settings but raised concerns about the compatibility of technological infrastructure that facilitates the sharing of optical coherence tomography image and video files. Some optometrists were also concerned about the financial sustainability of the intervention after the end of the trial due to the costs involved in the administration of QnAMD follow-up care.Conclusions The delivery of QnAMD services in the community by non-medical personnel was broadly accepted by both patients and practitioners. This implies that non-medical practitioners can follow up patients with QnAMD in the community in a safe way. Further research would be needed to establish whether similar results would be obtained during routine practice outside a research project and whether the long-term follow-up for QnAMD would be financially sustainable for independent as well as chain community optometry practices.Trial registration number NCT03893474.
Background: African-derived populations are disproportionately affected by primary open-angle glaucoma (POAG) and face increased risks of surgical failure due to anatomical and genetic factors. This report identifies challenges in glaucoma care and strategies to optimize surgical outcomes in patients from African-derived backgrounds. Methods: Six UK-based consultant ophthalmic glaucoma surgeons with extensive experience in diverse patient populations convened to discuss challenges and key approaches for optimising glaucoma filtration surgery outcomes in African-derived populations. Their opinions were supplemented by published literature to propose tailored recommendations and address some of the known challenges in this important patient group. Results: Surgical treatment of glaucoma among African-derived populations includes challenges such as Tenon's thickness, variable wound healing, and an increased risk of scarring. Preoperatively, outcomes can be improved through patient education, counselling and ocular surface optimisation, including reduction of preservative exposure. Intraoperatively, surgeons may consider the use of general anaesthesia or conscious sedation in younger patients, higher or prolonged mitomycin C exposure tailored to individual risk, and separate closure of Tenon's capsule and conjunctiva to reduce bleb failure. Proactive postoperative care should include intensified steroid regimens and 5-fluorouracil use when indicated. Conclusion: These insights support the delivery of culturally informed, evidence-based glaucoma care tailored to patients from African-derived backgrounds. By adopting a personalised and proactive approach, healthcare professionals may achieve more consistent and favourable surgical outcomes in this high-risk group.
Therapies with robust visual outcomes and reduced patient and healthcare system treatment burden are needed amidst the rising incidence of neovascular age-related macular degeneration (nAMD). Aflibercept 8 mg is an additional treatment option with demonstrated potential for extended dosing intervals of up to 24 weeks. The objective of this publication is to introduce a clinical care pathway, developed by expert consensus of experienced UK clinicians, to support best practice with aflibercept 8 mg in nAMD. A structured, face-to-face roundtable meeting of 13 UK retina specialists was held on 8 October 2024, organised and funded by Bayer. The expert panel reached consensus following review of key clinical trial data and consideration of current NHS clinical practice to provide guidance on the use of intravitreal aflibercept 8 mg in nAMD. The panel provided recommendations for an aflibercept 8 mg treat-and-extend pathway for both treatment-naïve and previously treated patients with nAMD. Criteria were developed to guide dosing interval extension, reduction or maintenance based on visual acuity and optical coherence tomography imaging. More detailed guidance includes considerations for switching treatments to or from aflibercept 8 mg, monitoring, and discontinuing treatment. Aflibercept 8 mg may offer opportunities for longer treatment intervals and reduced patient and clinic burden compared with first-generation agents. The proposed treatment pathway is practical and accounts for variability in healthcare structures and capacity pressures, providing clinicians with flexibility in implementing these recommendations while addressing patient needs.
