Community care services

Chris Mody discusses the impact of community care services

With an ageing population and financial pressure on acute services, the commissioning of eye care services in the community is rapidly increasing.

Organisations tendering for these contracts nationwide include GP practices, outreach clinics, mobile ophthalmology services, as well as local optical committees (LOCs).

While optometrists are well placed to become primary eye care providers, the competition is fierce with ‘any willing provider’ able to respond to the call. The use of community-based referral refinement schemes by optometrists have been proven to work well for conditions such as glaucoma, and recent research has found that optometry based community care for routine monitoring of neovascular age-related macular degeneration (AMD) can be just as effective as hospital-based care (Echoes trial).

The research team, led by Professor Usha Chakravarthy of The Queen’s University of Belfast, found that the decisions made by optometrists and ophthalmologists were consistent and that after training, optometrists based in the community were as good as hospital-based ophthalmologists. AMD triage in optometric practice is already a reality in some parts of the country, including Brighton and Rochester. High-resolution OCT imaging that delivers accurate and repeatable measurements is essential to make confident referrals into ophthalmology.

OCT image of neovascular age-related macular degeneration

So how can independent optometrists take advantage of the commissioning of community-based shared care services? Engagement with local optical committees and LOCSU to create business cases for community services and working closely with commissioners will ensure that optometrists are well informed and aware of opportunities. Further education and investing in the right equipment are also critical to success. Diagnostic equipment that is modular and upgradeable is always a wise investment, as it enables the optometrist to add new modalities that provide additional information to enhance clinical decision making.

Visit to read about how real OCT owners integrated the technology successfully into their practice.

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