“Optometrists are critical to supporting glaucoma care in both primary and secondary care”

This Glaucoma Awareness Week (30 June–6 July), OT heard from optometrists in the community and hospital settings on the important role the profession can, and could, hold in glaucoma care.

Contributors also discussed the effect of further education and qualifications, and offered their top myth buster when it comes to discussing glaucoma with patients.

“Much more can be done by optometry, particularly in delivering follow-up in primary care”

As a consultant optometrist and head of optometry at Manchester Royal Eye Hospital, Patrick Gunn’s role sees him involved in delivering glaucoma laser procedures and working in glaucoma clinics for patients with complex needs – mainly those undergoing surgery.

Gunn is also active in glaucoma-related research, delivering the Manchester professional certificate in glaucoma.

He told OT: “I also work with our amazing primary care colleagues who deliver enhanced glaucoma services in Greater Manchester.”

Describing his further study in glaucoma, Gunn explained: “I completed the old-style College of Optometrists’ diploma in glaucoma soon after I started at the Manchester Royal Eye Hospital.”

“I found preparing for case record submissions really valuable, as there was a strong focus on reflective, critical practice. I definitely bring reflection into my own clinical practice in glaucoma and feel it’s vital to improve as a clinician,” he said.

Engaging with colleagues to discuss cases was another key skill developed through the qualification, Gunn said, telling OT: “That really enhances your confidence and experience working in glaucoma clinics.”

Earlier this year, Gunn was recognised in Glaucoma UK’s Excellence in Glaucoma Care Award.

Talking to OT about the role of optometry in glaucoma services, Gunn said: “Optometrists are critical to supporting glaucoma care in both primary and secondary care.”

Primary care optometrists detect the majority of cases of glaucoma in the UK, Gunn noted, adding that the profession also “contributes enormously to ensuring only appropriate cases are referred to secondary care through enhanced case finding.”

In secondary care, optometrists are providing glaucoma related care, and many have leading roles in service development and management, he shared.

He said: “Optometrists lead glaucoma research, are involved in developing clinical pathways, and contribute to national guidance. Given the increasing demand for clinical care in glaucoma, much more can be done by optometry, particularly in delivering follow-up in primary care.”

“I think glaucoma, like many areas of optometry and ophthalmology, is ever-changing”

Pamela Robertson, independent prescriber (IP) optometrist, founder and clinical director of Angus Optix, a Hakim Group independent practice, is currently undertaking the NES Glaucoma Award Training (NESGAT).

The practice already carries out community glaucoma services, working with the local hospital to perform visual field testing, take pictures and record intraocular pressure (IOP).

Once Robertson has completed the NESGAT qualification, she will be able to manage glaucoma patients autonomously, including changing treatment plans.

Taking on the NESGAT was a “natural next step” for Robertson, who has a Master’s in primary care ophthalmology and has had IP for 15 years.

“I’m still learning. I think glaucoma, like many areas of optometry and ophthalmology, is ever-changing. There is always something new on the horizon,” she shared, adding: “It’s about keeping your skillset up to date.”

Robertson told OT: “I think optometry is so pivotal for diagnosis, and that the hospitals just do not have the facilities to carry out all the checks repeatedly that are needed to be able to facilitate diagnosis.”

There is a common misconception that glaucoma can be “straightforward,” Roberston suggested, explaining: “It takes quite a number of visits, with serial photographs, visual fields, and IOP measurements. Particularly in cases where it is maybe a little more ambiguous, like normal tension glaucoma, and the hospitals just do not have the resources.”

The optometry profession is able to offer that service in the community, with or without ophthalmology input, Roberston shared.

“If you’ve got the additional qualifications, there is absolutely no reason why an optometrist should not be undertaking that role,” she said.

“Optometrists are ideally positioned to not only screen for, but manage, this condition within the community”

Imogen Hawthorne is an advanced clinical practitioner optometrist with roles in academia and hospital optometry, and is also deputy clinical lead for ophthalmology at a community ophthalmology service in the Midlands.

“While my role involves some operational running of the service, I still spend a lot of time in clinic; much of which is seeing and treating glaucoma patients who attend with varying stages of the disease,” she explained.

Hawthorne highlighted: “Supporting our patients holistically is a big priority, and I do this through organising patient engagement events to teach about the disease and give patients the opportunity to ask questions outside of the consulting room.”

Sharing her experience in glaucoma services, Hawthorne explained that she has worked in glaucoma clinics for more than 15 years.

While training was provided through the hospital trust, Hawthorne has also completed the College qualifications, gained IP, and is completing the diploma in glaucoma.

She added: “Having been performing YAG capsulotomy for more than five years, last year I was also lucky enough to be supported to train in peripheral iridotomy and selective laser trabeculoplasty.”

The training was provided through a course provided locally, and further training has been provided through a mentorship from a consultant colleague.

She shared: “By formally developing my skills I have been able to develop a high level of autonomy in my practice, which has been incredibly rewarding.”

Considering the role for the profession in supporting patients with glaucoma, Hawthorne said: “With approximately 2% of UK adults over 40 affected by glaucoma, optometrists are ideally positioned to not only screen for, but manage, this condition within the community.”

Hawthorne pointed out that many of the independent sector providers have demonstrated how optometrists can work autonomously in the pre- and post-operative care of cataract patients, but also, lead services effectively.

Structured training frameworks are already in place with the Ophthalmic Common Clinical Competency Framework and College Higher Qualifications facilitating optometrists to gain a higher level of autonomy in glaucoma care, she said.

This, Hawthorne said, “along with the work looking at optometrist provision of selective laser trabeculoplasty by Moorfields and UCL Institute of Ophthalmology, have proved that optometrists can work safely delivering and prescribing treatments as part the current NICE guidance.”

“While commissioning has been a barrier, ongoing changes are now opening avenues for more optometrists to upskill and expand their role in glaucoma care delivery,” she added.