STAC – Stable Wet AMD in the Community 

Who is this service for?

STAC is a service for patients with stable wet AMD who have not received any treatment for more than 6 months and less than 2 years. They must have a Herefordshire GP and can only be referred to an accredited practice/practitioner with a contract to provide STAC. 

How is the patient discharged to STAC?

The decision to discharge STAC is made within virtual review clinics at HES. The STAC paperwork is completed by the hospital clinician and the retinal team (RT) will be in contact with the patient to confirm their preferred practice to be referred to. 

RT will then complete the discharge module on Pharmaoutcomes which sends a notification to the designated practice. The practice will then accept or reject the referral. 

• If rejecting, please also contact the retinal team separately to discuss why. 

• The RT referral should indicate whether the patient requires either a: 

scan at 2 weeks post-discharge to act as a baseline (this is typically done if they have ambiguous features) or normal pathway scan at 3 months post-discharge. 

Who can perform a STAC appointment?

The accredited optometrist must hold, or be overseen by someone who holds, the College of Optometrists Professional Certificate in Medical Retina.  

What must a STAC appointment consist of?

A STAC appointment must contain the following:

• Comprehensive history and symptoms detailing any new patient symptoms 

• LogMAR VA and pinhole 

• Dilation with tropicamide 1%

• Dilated macular OCT

Indications for re-referral:

• Reduction in vision by 5 or more letters associated with an enlargement in area of subretinal hyperreflective tissue growth (CNV)

• Presence of any new haemorrhage

• Presence of new IRF or SRF

• Increase in size of PED

• Other (Specify)

NB: Re-referral from the community is not indicated if the eye in question has been deemed untreatable, even in the presence of new signs of active wet AMD in that eye. Re-referral is also not indicated for chronic features such as tubulations (as distinct from IRF) or stable atrophic spaces in the retina unless other signs of activity are present.  

What must be done after the appointment?

If the patient is stable, monitor every 3 months until 2 years after the last treatment and then discharge to self-monitoring.