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Optometry’s role in revolutionising glaucoma care

Why we believe utilising the optometric workforce can improve the way in which glaucoma care is delivered to patients in England

Optometrist examining patient's eyes

What’s happening?

Glaucoma is the term for a group of largely chronic conditions that damage the optic nerve, leading initially to a loss of peripheral vision that may ultimately lead to blindness.

There are an estimated 1.39 million people in the UK living with ocular hypertension and a further 708,000 living with glaucoma.1

Glaucoma accounts for around 20% of outpatient appointments1.

The number of people living with glaucoma is predicted to increase by 18% in the next 10 years and follow up appointments for glaucoma are predicted to increase by 20%.

Currently, most patients with glaucoma are seen and reviewed within hospital eye departments. This usually involves patients over the age of 70, who are unable to drive as their examination will often involve pupil dilating drops that blur their vision. These patients therefore are likely to be travelling by public transport, or collected by patient transport, or reliant on friends and family to take them to their hospital appointments.

These visits to the hospital may occur multiple times per year as patients are often scheduled on different days for differing tests, and one visit may involve a review with an ophthalmologist and another may involve being seen by a nurse or technician to have their visual field measured. These visits are expensive, time consuming and in many instances unnecessary for both the patient and the NHS.

What needs to change?

1. We think that glaucoma care should be delivered closer to where patients live, in locations which are easily accessible, by a well trained and well equipped workforce, with follow up appointments delivered within optometry practices

The details of how this will work takes two possible forms, articulated by the Royal College of Ophthalmologists in their ‘Glauc-Strat-Fast’2 document and supported by the College of Optometrists.

This document clearly sets out what additional training is required for optometrists to deliver care autonomously. We recognise that the challenge with autonomous management is that it is time consuming to achieve the highest qualifications, and the placements for training are difficult to obtain.

‘Glaucoma-Strat-Fast’ also sets out how care can be delivered collaboratively. It is this scenario which we think represents a unique opportunity for the NHS to utilise the optometric workforce and to revolutionise glaucoma care in the UK.

The current lack of a collaborative approach to care fails to utilise the highly skilled optometric workforce, which could ably supplement the insufficient number of ophthalmologists. In addition the lack of universal commissioning leaves patients at the whim of local commissioning decisions, this embeds inequity between areas and demonstrates the postcode lottery of patient care.

2. Glaucoma follow up appointments are within the core skills of optometrists. We think the system needs to change to reflect that

Optic nerve head assessment, visual field assessment, intra-ocular pressure measurement and optical coherence tomography (OCT) assessment of the optic nerve are conducted daily by optometrists. They are well practised and experienced in their usage and adept at detecting and acting on deviation from previous values. The equipment required is commonly found in optometric practices throughout the UK.

Operating in conjunction with ophthalmologists to set parameters and management plans, optometrists can manage practically all glaucoma patients. The only thing prohibiting the near instant transformation of UK glaucoma care is the lack of a suitable mechanism for collaboration between optometrists and ophthalmologists. The system is hamstrung by a lack of connectivity, a failure to invest systematically and consistency in connecting the parts of the system that would allow collaboration.

If enabled, optometrists can monitor patients, with those patients that deviate from the predetermined management plan reviewed virtually by a consultant or an optometrist with higher qualifications in glaucoma, where possible refinements to the patients medication will be made remotely with patients only returning to the consultant where it is essential for them to do so.

3. The lack of IT connectivity between optometry and ophthalmology inhibits patient care and needs to be improved

Improved IT connectivity needs to be a priority for the Government and NHS England to cut avoidable patient referrals between primary and secondary eye care. Read more in our policy position statement: Taking the right steps to drive IT connectivity for optometry

What are we calling for?

In summary a new approach, focusing on three core areas:

  • A collaborative approach to glaucoma care is needed, which utilises the extensive, highly skilled optometry workforce alongside secondary care
  • Effective IT connectivity for optometry is required to facilitate and underpin this new mechanism of care. The current outdated, siloed approach undermines patient care
  • Universal commissioning of glaucoma care for optometry to all patients is needed regardless of where they live, eliminating the postcode lottery of patient care

References

  1. Glaucoma UK
  2. www.rcophth.ac.uk/news-views/designing-glaucoma-care-pathways-using-glauc-strat-fast/