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Local eye injection programme for AMD ‘still on track’

Treatment in Lerwick could save money and patient distress

NHS SHETLAND says injections for two serious eye complaints may be delivered locally next year despite patient fears that plans to bring treatment from Aberdeen to Shetland had fallen by the wayside.

NHS Shetland’s director of nursing and acute services Kathleen Carolan said that plans to bring the injection service for “wet” age-related macular degeneration (AMD) and glaucoma to the Gilbert Bain Hospital were progressing despite “technical” setbacks.

It is hoped that an isles-based injection service can be in place in 2019 as soon as NHS Grampian has trained up nurses who will travel to Shetland to undertake the procedures.

At present 20 to 30 elderly, and in some cases infirm, patients are transported to Foresterhill Hospital in Aberdeen and back every month for injections of drugs that are intended to slow down the development of wet AMD, which leads to loss of sight.

NHS Shetland budgets each return trip at £375, though costs vary with some flights costing more and some patients electing to travel by ferry. Some patients also require an escort, usually a family member.

As well as the cost to the NHS, patients are also left out of pocket if they have to take unauthorised taxis and pay for overnight accommodation. Added to this is the hugely time-consuming business of travel, especially for those coming from the outer isles.

Problems with the programme to introduce the service locally came to light when patients travelling to Aberdeen were told in conversations with staff that the scheme had been shelved.

Carolan said: “The programme has not been discontinued, we are working on this service and a virtual glaucoma service with NHS Grampian and they are ongoing projects.

NHS Shetland director of nursing and acute services Kathleen Carolan
NHS Shetland director of nursing and acute services Kathleen Carolan

“Our original plan was to train a nurse to provide the service in Shetland but that has not proven to be technically viable. Instead, NHS Grampian is training nurses with the intent of providing a visiting service to Shetland.

“We are also addressing a number of file sharing issues between the two health boards so that images that are taken of patients’ eyes, which are used to determine if therapy is required, in Shetland can be viewed by the ophthalmologists in Aberdeen.”

Of the existing service, she added: “We recognise that this means frequent travel for patients and that is why we are working on developing a local service option; we do need to do this in conjunction with NHS Grampian and they are in the process of training more nurses in order to ensure that they can provide a consistent service to both Aberdeen and Shetland patients.”

According to the Macular Society, which set up a Shetland branch in July with the cooperation of the NHS and Shetland Islands Council, the “burden of treatment for patients with wet AMD is huge”.

A spokesperson said: “Most patients need to return to hospital, sometimes as often as every month, to receive an injection. This can have a huge impact on the individual’s life, as well as the life of their friends and loved ones.”

Macular Society regional manager John Furze added: “While the treatment for patients with wet AMD helps to preserve vision, it imposes a substantial burden on patients with the need for regular appointments at a hospital eye clinic.

“If patients in Shetland are required to travel to Aberdeen this will mean a 14-hour journey, each way, in order to receive vital sight-saving treatment.

“We would urge NHS Grampian and NHS Shetland to look again at providing a local service option for those living on the island.”

AMD largely affects people over the age of 60 with the risk of developing the condition increasing with age. There are two types of AMD, known as “wet” and “dry”. While there is treatment for wet AMD, the dry type of the condition is untreatable.