Trends in provision of photodynamic therapy and clinician attitudes: a tracker survey of a new health technology

National postal questionnaire survey of clinicians with potential responsibility for PDT provision. The survey explored reported local provision, beliefs about the effectiveness of PDT and what sources of opinion might influence attitudes towards providing PDT.The response rate was 73% (111/150). Almost half of the surveyed ophthalmology units routinely provided PDT, as part of a trend of steady growth in provision. The proportion of respondents who believed that further proof of effectiveness was required has also declined despite the absence of any new substantial evidence. Attitudes towards providing PDT were positive, on average, and were more strongly associated with perceived social pressure from local colleagues than from other sources. Local colleagues were seen as being most approving of PDT.Those responsible for implementing the NICE guidance need to address ophthalmologists' beliefs about the evidence of effectiveness for PDT and draw upon supportive local individuals or networks to enhance the credibility of the guidance.Age related macular degeneration (ARMD) is the commonest cause of severe loss of central vision in people aged over 50 in the Western world [1] and accounts for almost 50% of those registered as blind or partially sighted in the UK [2]. One form of the disease, neovascular ARMD, is more aggressive and accounts for up to 15% of cases [1]. Evidence from two randomised trials indicates that photodynamic therapy (PDT), administered five to six times over a two year period, reduces the relative risk of losing three or more lines of visual acuity over two years [3,4]. In particular, a subgroup analysis has shown a statistically significant benefit in the prevention of visual loss in people with wholly or predominantly classic choroidal neovascularisation (CNV). These findings contributed to pressure upon the UK National Health Service (NHS) from both patient and professional groups to make this therapy routinely available [5,6]. However, syste