BMJ open · 2026
What is the patient experience of receiving lifestyle advice regarding age-related macular degeneration (AMD) in secondary eye care? A multimethods study.
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Dave Sonali, Binns Alison M, Vinuela-Navarro Valldeflors, Callaghan Tamsin
Аннотация
OBJECTIVES: Age-related macular degeneration (AMD) is a progressive condition which can lead to irreversible sight impairment. While there is no cure for early or intermediate AMD, modification of lifestyle risk factors (smoking, dietary changes and vitamin supplementation) can slow down disease progression. Although professional guidelines recommend that clinicians provide lifestyle advice to patients, evidence suggests that this may not be provided consistently. This study aimed to investigate the experiences of people with AMD receiving lifestyle modification advice in secondary eye care to determine the current status of advice provision and to explore patient opinions regarding the optimal mode of communication.
DESIGN: Multimethods survey study.
SETTING: Primary and secondary care centres in England.
PARTICIPANTS: To be included in the study, participants had to have a diagnosis of AMD in at least one eye. This could be of any stage (early, intermediate or late according to the Beckman classification system). Participants were excluded if they had bilateral end-stage AMD (fovea involving geographic atrophy or scarring secondary to neovascular AMD), if they had received more than three rounds of anti-vascular endothelial growth factor (VEGF) injections in their first diagnosed eye or if they had other ocular conditions affecting the retina or optic nerve. Recruitment took place via 10 hospital clinics and 24 optometry practices.
INTERVENTION: Eligible patients were sent a survey to complete online or on paper, including three sections: demographic, historical experiences of lifestyle advice and experiences at the most recent appointment. Participants were asked to complete the survey within three weeks of attending their appointments.
RESULTS: Exploratory descriptive analysis was conducted of quantitative data. Qualitative data were thematically analysed using NVivo V.12. 404 participants were included in the study. Most were female (n=244; 60.4%), recruited via hospital clinics (n=398; 98.5%) and diagnosed within the last year (n=152; 37.6%). The majority reported never having received lifestyle modification advice from an eye care practitioner (ECP) (n=209, 51.7%). Of those that reported receiving advice prior to their most recent appointment (n=125), 63% reported making subsequent changes. 300 participants (84% of respondents) reported not receiving advice at their most recent appointment. Only 25% were asked about their current smoking habits and only 2 (8.3%) of current smokers recalled being given advice to stop smoking. The most common type of advice received was regarding diet. A combination of verbal and written information was the preferred mode of advice provision, yet only 9.4% were given written advice.
CONCLUSIONS: Despite the guidelines, the findings from this study show that advice is not consistently being provided to patients in their preferred formats. A clearer framework of patient informed guidelines is needed to improve lifestyle advice provision by ECPs.
DESIGN: Multimethods survey study.
SETTING: Primary and secondary care centres in England.
PARTICIPANTS: To be included in the study, participants had to have a diagnosis of AMD in at least one eye. This could be of any stage (early, intermediate or late according to the Beckman classification system). Participants were excluded if they had bilateral end-stage AMD (fovea involving geographic atrophy or scarring secondary to neovascular AMD), if they had received more than three rounds of anti-vascular endothelial growth factor (VEGF) injections in their first diagnosed eye or if they had other ocular conditions affecting the retina or optic nerve. Recruitment took place via 10 hospital clinics and 24 optometry practices.
INTERVENTION: Eligible patients were sent a survey to complete online or on paper, including three sections: demographic, historical experiences of lifestyle advice and experiences at the most recent appointment. Participants were asked to complete the survey within three weeks of attending their appointments.
RESULTS: Exploratory descriptive analysis was conducted of quantitative data. Qualitative data were thematically analysed using NVivo V.12. 404 participants were included in the study. Most were female (n=244; 60.4%), recruited via hospital clinics (n=398; 98.5%) and diagnosed within the last year (n=152; 37.6%). The majority reported never having received lifestyle modification advice from an eye care practitioner (ECP) (n=209, 51.7%). Of those that reported receiving advice prior to their most recent appointment (n=125), 63% reported making subsequent changes. 300 participants (84% of respondents) reported not receiving advice at their most recent appointment. Only 25% were asked about their current smoking habits and only 2 (8.3%) of current smokers recalled being given advice to stop smoking. The most common type of advice received was regarding diet. A combination of verbal and written information was the preferred mode of advice provision, yet only 9.4% were given written advice.
CONCLUSIONS: Despite the guidelines, the findings from this study show that advice is not consistently being provided to patients in their preferred formats. A clearer framework of patient informed guidelines is needed to improve lifestyle advice provision by ECPs.