The evolution of glaucoma care at Moorfields Eye Hospital

Independent prescribing optometrist, Emma Laber, provided a whistlestop tour of how optometrist involvement in glaucoma care has evolved at Moorfields Eye Hospital during her presentation at the Hospital and Specialty Optometrists Conference (London, 8–9 November).

Beginning her presentation, Laber outlined the progress the profession has made since an optometrist first volunteered at a Moorfields Eye Hospital glaucoma clinic in 1990.

She highlighted that between 2005 and 2023 the number of optometrists working in glaucoma clinics at Moorfields Eye Hospital increased from 13 to 95.

Optometrists have increasingly played a role in delivering selective laser trabeculoplasty and diagnostic virtual reviews.

Laber shared that an audit of an optometrist virtual review service found a high level of agreement in management decisions and follow-up durations between optometrists and ophthalmologists.

“It was a new way of working because we were used to seeing patients face-to-face,” she said.

“With that movement of lower risk categories into virtual clinics, it meant that a broader inclusion of patients could go into the optometrist face-to-face clinics. We are now dealing with any stage of disease and any type of glaucoma,” Laber said.

She added that there was a shift in mindset from reviewing patients face-to-face by default to virtual review.

“We were aiming to free up that really precious commodity of consultant time to review those patients who really need it,” Laber highlighted.

She shared that an audit of the care provided by optometrists to higher-risk glaucoma patients found that 66% were managed autonomously by optometrists.

“Within this group, there was very high agreemen – 93% – with consultant management plans,” Laber said.

She observed that changes within the glaucoma service at Moorfields Eye Hospital have been supported by optometrists undertaking higher qualifications.

Laber noted that one in four optometrists working within the Moorfields Eye Hospital glaucoma service hold both a glaucoma diploma and independent prescribing qualification.

“Has that made any difference for service delivery? Yes, I am pleased to say. At last count, in October, we now deliver over 200 clinical sessions per week across the trust,” she said.

She added that at the City Road site, optometrists deliver around half of virtual reviews within the glaucoma service and a third of face-to-face visits.

“Those numbers don’t include those who are seen by optometrists working in a consultant-led model,” she said.