28 March 2024
The Eyes Have It (TEHI) partnership focused on strategies for prevention during its panel at 100% Optical 2024 (24–26 February).
TEHI members Keith Valentine, chief executive officer of Fight for Sight, and Peter Bloomfield, director of research at the Macular Society, were joined on stage by the AOP’s clinical and professional director, Dr Peter Hampson, consultant ophthalmologist, Dr Christiana Dinah, and national clinical director for eye care, Louisa Wickham, for the discussion.
Tori Griffiths, public affairs partner at Roche and a member of TEHI, chaired the panel, which was entitled Strategies for prevention – new opportunities across the eye care sector to prevent avoidable sight loss.
Wickham opened the session by laying out the power of prevention, including that reducing the prevalence of eye conditions by 1% per year could save the UK economy £9 billion by 2050.
“If there is one thing we can really do about prevention, it is to ensure that we have minimal delay for patients to access the right healthcare and the right diagnosis,” Wickham said.
She added that NHS England has been engaging with healthcare providers around the country, and in doing this “it became very clear that many systems were already able to respond to the challenges that they see in eye care.”
“They are already understanding that there are things, fundamentally, that we need to do differently,” Wickham said.
Systems on a local level have, in some cases, started redesigning in order to tackle the challenges that they are facing, with limited national support, she added.
Wickham shared that one thing NHS England can do is support users to develop more telehealth pathways.
“Using telehealth can enable better communication between community and hospital eye services, whether it be from data sharing, whether it be through mail, whether it be through joined-up pathways,” Wickham said, adding that NHS England can encourage regions to work together to progress in this area.
Using telehealth can enable better communication between community and hospital eye services
She explained that more efficient and effective use of hospital services were seen through a trial in Central London that saw a reduction in the number of referrals and avoidable appointments, first for age-related macular degeneration patients and then more widely.
Seeing the right practitioner at the right time, along with ongoing education and management, made this possible, Wickham said.
“The number of touch points, how often the patient had to come into contact with healthcare professionals, reduced,” Wickham said. “We also saw a significant reduction in delays for a patient presenting to actually having a clinic appointment and having that information and diagnosis.”
The number of clinic visits that were unnecessary fell from 71% to 38%, she said.
Wickham noted that implementing this pathway more widely would have a significant impact on waiting lists.
Harnessing optometrists in the community to their highest skill level is key to this, she believes.
“We need to make sure that that pathway is integrated. We need to ensure that there is really good communication between what happens in the community and what happens in eye hospital services, and vice versa,” she said. “That really requires us to think about how we share data, and how we communicate.”
She added that digital connectivity can be as simple as making sure all optometrists in the community have an NHS Mail account, or utilising a single point of access for telehealth that optometrists can easily use.
Image sharing across the eye care community, better service specifications, and minimum datasets, are also needed, Wickham said.
She added: “There is a world out there where, if we are organised in a way where our infrastructure supports data acquisition and data sharing with large numbers of patients, the opportunities for us to do early diagnosis, prevention, education, and really address the loss of vision that is preventable and irreversible, will fundamentally change how we provide eye care today.”
“The only way that we can seize all the opportunities that lie ahead of us is by working together,” Wickham believes.
Harnessing the skills of the optometry workforce
After Wickham’s intro, Griffiths directed questions towards the panel in a conversation that included the potential of the optometry workforce in disease prevention.
Griffiths began by asking, in the context of there being 17,500 registered optometrists in the UK, what national support might be needed to allow the skills of this workforce to be harnessed.
“If we can utilise that workforce, we can find disease sooner, and we can prevent things progressing to the stage where they need interventions for anything serious,” Hampson said.
He added that, amongst the public, the importance of regular eye tests should be emphasised so that disease can be identified early.
Dinah shared that digital connectivity could help solve the issue of not hearing back about patients’ outcomes after referral, which is something often raised during teaching sessions that she hosts with local optometrists in north west London.
Optometrists are regularly telling her that they have to ask the patients themselves or chase medical secretaries for an update, Dinah said.
“I don’t think, as a community, we’ve embraced that or integrated it into a holistic way of delivering eye care, and that’s a big mistake,” she said.
She added: “It also feeds into the fact that the funding models need to change because, sadly, there is now a two-tier system developing, where some people have access to levels of diagnostics in the community and others don’t, which means you start to get this chasm between those who present early and those who present late.”
These are things that she would like to see a national strategy address, Dinah said.
Speaking about optometrists, Dinah added: “That skill set, that is already out there, is essentially extra capacity. We’re not embracing it, and we’ve got a million people on waiting lists.
“There seems to be a lack of understanding of where the gaps are, where the capacity is, and how we can harness it to use for the entire eye care pathway.”
Examples of success in pockets of the country should be looked at nationally, Dinah believes.
She noted that glaucoma is more prevalent and can appear a decade earlier in certain demographics, but at the moment there is no targeted outreach for these at-risk groups, leaving practitioners “struggling to ensure that they’re seen.”
This “causes systemic inequalities,” Dinah said.
Addressing the community optometry workforce, accessing data and digital technologies, and sharing results, will lead to better and more accessible healthcare, she added.
This is “the core essence of what we do,” Dinah believes.
Hampson believes that “Some of the challenges are too big to tackle on our own.”
Both optometrists and ophthalmologists might explain that they do not have the data or the information that they need, but the only way to tackle challenges such as funding is for the different professions to come together, Hampson said.
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