Presentation (CTI)

OBJECTIVES: In this study, we aim to analyze the healthcare landscape and describe the actual patient pathway for patients with neovascular age-related macular degeneration (nAMD) in the Czech Republic through specialist interviews to identify operational bottlenecks and systemic barriers to timely anti-VEGF treatment.
METHODS: The qualitative study utilized in-depth semi-structured interviews at 23 specialized centers (retina specialists and nurses), which allowed us to identify complex systemic issues.
RESULTS: Interviewees noted delays in a leading time from the first diagnostic suspicion to treatment initiation up to 5 months. Delays were primarily driven by (1) low disease awareness among the elderly, leading to late presentation at primary ophthalmology clinics; (2) prolonged waiting times for initial consultations in primary ophthalmology; and (3) significant application capacity constraints at specialized centers. These constraints are primarily caused by the requirement for a dedicated operating room to administer injections, staffing shortages, and restrictive budget caps. To optimize the treatment pathway and enhance capacity interviewees proposed: (1) decentralizing care by allowing injections in qualified ambulatory settings; (2) expanding the network of specialized centers alongside increased staffing and funding; and (3) introducing task-shifting models that authorize trained nurses to perform intravitreal injections.
CONCLUSIONS: To address the critical treatment delays and alleviate the overburdened specialized centers, comprehensive systemic changes are required. By improving health literacy and modernizing the delivery model, the healthcare system can eliminate unnecessary delays and ensure timely, vision-preserving interventions for nAMD patients.