We found that all participants either “agreed” (54%) or “strongly agreed” (56%) that drug licensing regulations were a challenge in offering wet AMD patients Avastin. Nobody “disagreed” or “strongly disagreed” that concerns over GMC action (23% neutral, 31% agree, and 46% strongly agree) and drug company marketing (38.5% neutral, 23% agree, and 38.5% strongly agree) were also an issue. A greater range of responses was recorded for patient understanding and misinformation (8% disagreed, 38.5% strongly agreed), Trust/Health board negotiation & policy (15% disagreed, 31% strongly agreed) and management support & leadership (15% disagreed, 31% strongly agreed). The greatest variation in responses was seen for ethical concerns (15% strongly disagreed, 38.5% strongly agreed) and legal implications (8% strongly disagreed, 38.5% strongly agreed).

Of the comments received a reoccurring theme was capacity, and whether current infrastructure can subsume the increased number of intravitreal injections (IVT) per patient required with Avastin compared with Lucentis [2]. Examples of feedback included: ‘need to have a significant increase in clinic capacity’ and ‘capacity in IVT will worsen if Avastin introduced, needs to be addressed first’. Another theme was the lack of support from key players: ‘This is a regulatory matter, to be solved by the regulators (MHRA) [Medicines and Healthcare products Regulatory Agency] and government. Doctors should not be being put in this position,’ and “The college and professional bodies have not been as strong a lobby as they should have been’. Interestingly, some unique change ideas were also suggested by the consultants surveyed. These ranged from: ‘need to change SOP [Standard Operating Process] for nurse injectors’ and ‘public information exercise needed…RNIB [Royal National Institute for the Blind]/ Macular Disease Society could help inform’ to ‘trusts should offer Avastin only as first line’.

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