Assessing the viability of non-medical practitioners conducting photocoagulation for PDR (AVENUE-PDR): A feasibility trial

Aims and objectives 

To investigate the feasibility and acceptability of trained non-medical professionals (eye care practitioners (ECPs)) performing laser treatment for proliferative diabetic retinopathy (PDR), and the potential impact on service capacity. 

The primary objective is to assess the feasibility of conducting a full trial comparing trained ECPs with ophthalmologists in performing laser treatment in line with the established protocols. 

The secondary objectives are to determine the following: 

• Investigate whether it is possible to recruit and retain participants into a randomised trial and determine the rates of recruitment and retention, and the sample size required to power a full randomised control trial (RCT).
• Appropriateness of inclusion/exclusion criteria, randomisation protocol, outcome measures from a patient perspective
• The feasibility of collecting data for statistical and health economic analysis
• Feasibility of delivering the ECP led treatment. • The main cost drivers of ECP led treatment compared with treatment as usual.
• The content of ‘treatment as usual’ by an ophthalmologist and treatment by an ECP to describe and cost the treatments.
• The content of ECP led laser treatment and the related training to develop treatment and training manuals.
• Determine whether it is acceptable to people with diabetes as well as other healthcare professionals for ECPs to perform laser.
• Feasibility of collecting patient reported experience measures using PREMs
• The availability of the Navilas or other suitable lasers and the potential workforce within NHS England and Wales to deliver this service in a full trial setting and enough ophthalmologists to train and supervise these staff in delivering laser treatment.