NICE-Informed Quality Improvement for Neovascular Age-Related Macular Degeneration: A Single-Centre Two-Cycle Audit of the Two-week Referral-to-Injection Standard.

Purpose: Neovascular age-related macular degeneration (nAMD) is a time-critical cause of irreversible central vision loss. National audit standards operationalise timely treatment as intravitreal anti-VEGF therapy within two weeks of community referral. This retrospective, single-centre, two-cycle quality improvement audit evaluated compliance with the referral-to-first-injection (RTFI) standard and the impact of targeted service optimisation on pathway performance and early outcomes. Methods: Cycle 1 included 81 consecutive community referrals receiving first intravitreal injection for nAMD at Luton and Dunstable University Hospital (March-December 2024); Cycle 2 included 50 patients (May-November 2025). The primary outcome was the proportion meeting the two-week RTFI target. Referral-to-first-appointment (RTFA) and first-appointment-to-first-injection (FATFI) intervals were analysed as pathway components. Secondary outcomes were change in ETDRS visual acuity and OCT-derived central macular thickness (CMT) between baseline and first post-injection follow-up. Following Cycle 1, interventions included a one-week internal assessment deadline, increased injection capacity, and enhanced clinician awareness of referral timelines. Results: Demographics were similar across cycles (Cycle 1: 60% female, median age 84; Cycle 2: 54% female, median age 81). Two-week RTFI compliance increased from 41% (33/81) to 76% (38/50) after service optimisation (χ Conclusion: Pragmatic service redesign was associated with significantly improved compliance with the two-week RTFI standard for nAMD, driven by faster first assessment and more reliable injection delivery. Residual delays were predominantly patient-related, supporting patient-facing interventions and further audit cycles to assess sustainability.