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Serena Salvatore: advisory board for Advanz Pharma, Bayer, Roche and Alimera Sciences; speaker fees and travel support from AbbVie, Sandoz, Alimera Sciences, Bayer and Roche. Amy Hughes: head of research, Primary Eyecare Services. Lisa Gibson: clinical director, Primary Eyecare Services. John Hopcroft: chair, Avon Local Optical Committee. Josh Harvey, Sarah Swift and James Marsterson declare no competing interests.","order":1,"name":"Ethics","label":"Conflict of Interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was conducted as a retrospective service evaluation using routinely collected, fully anonymised clinical data. The project was registered with the Clinical Audit Department at University Hospitals of Bristol and Weston NHS Foundation Trust (reference A&EP\/CA\/202526\/01). In line with UK Health Research Authority guidance, formal research ethics committee approval was not required. 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