There have been 2 or 3 slightly different referral forms in use for suspected wet AMD patients. From 8th Feb 2010 the PCT have launched a single integrated fast track referral pathway for this service.

The PCT has contracted with 2 providers for provision of fast  track wet AMD assessment and if necessary  Avastin/Lucentis injections. These services are provided by Mr Kotamarthi at Leighton hospital  and Mr Needham at Eyecare Medical Ltd in Macclesfield.

Patients who meet the referral criteria (which are detailed on the referral form) should be asked which provider they prefer to be seen by and  referral form  faxed to the appropriate number as shown on the form. Patient with dry AMD who require hospital attention (eg for provision of LVAs) should be referred via the patients GP in the usual way.

There is no fee for this service as the referral form is simlpy a replacement for the GOS18 which would need to be filled in anyway. The main aim of this service is to ensure that patients suitable for antiVEGF treatment are seen and assessed urgently.

The referral form is provided to the right of this page both as a normal Word document to print out and fax or as Word .DOT template which can be filled in electronically and printed out before faxing. The CCOphth guidance photographs  (shown as a thumbnail above)  are also available for reference. The .ZIP file contains all the information files and letters that were sent out with the original info pack from the PCT