Our findings demonstrate that presentation delay represents a major source of delay and accounts for the greatest proportion of the delay in the nvAMD care pathway in Southeast Scotland. This represents an important target for improvement to reduce vision loss resulting from delay in the nvAMD care pathway.26 This delay is likely to be complex and multifactorial, involving patients, eye care providers and healthcare systems. Barriers to early presentation might include a lack of awareness of AMD among patients, self-examination by patients and screening of the disease by non-retina specialists. This can be further compounded by issues such as transport difficulties, age-related infirmity and a mismatch between patient expectations on speed of referral and recommended guidelines.27 Further studies are warranted into the reasons underlying our findings in both primary care and hospital eye service environments in order that appropriate measures are taken to identify patients early and build service capacity accordingly.