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Glaucoma care

Provide glaucoma care in community optometry and cut hospital referrals by 50%

Optometrist checking patient's eyes for glaucoma

Diagnosing and monitoring glaucoma in community optometry schemes has been shown to reduce the referral rate by as much as 50%.

Glaucoma is one of the most common conditions leading to sight loss in the UK. Due to the nature of the disease, the symptoms which present themselves at the beginning are difficult to diagnose and initial tests can often return false positives.

Glaucoma referral refinement schemes in community optometric settings have been shown to successfully diagnose patients in the community and reduce the referral rate into hospital by as much as 50%.

This significantly reduces the burden on hospital eye departments and ensures patients have access to high-quality, specialist care faster.12

Upon the diagnosis of glaucoma, patients require ongoing monitoring of their condition. Currently, this is often carried out by hospital eye services. However, in some areas, stable glaucoma monitoring schemes delivered by community optometry have taken on this service.

In cases where glaucoma is classified as ‘low risk’ or ‘stable’, these patients still require monitoring including pupil dilation to examine the inside of the eye, visual field testing and eye pressure checks several times a year and this can be done in community optometry.

A 2018 study of 5521 patients who were provided with care within the HES for glaucoma monitoring shows that 15% (1350) experienced a delay for their appointment, while 384 (4%) were discharged to a specialist community glaucoma optometrist. As many as 2035 (22%) patients were therefore seen more promptly, as well as safely by community optometrists.14 Research captured in 2023 reveals that more than three in four optometrists do not provide glaucoma monitoring, more than half (56%) say they have the tools, resources and skills needed to deliver the service.15

Furthermore, our cost analysis indicates that by utilising primary care optometry for glaucoma monitoring, in conjunction with schemes that look to reduce referrals into hospital eye services (HES), could achieve a cost saving of between £36m and £72m (based on 2020/21 glaucoma patient volumes). Using patient volume projections for 2030/31 these figures rise to between £46.5m and £93.5m.

How stable glaucoma is managed

  1. Patient is diagnosed with glaucoma
  2. Their level of risk of visual loss from glaucoma is assessed
  3. High risk patients are seen by the HES for continued management
  4. Stable glaucoma patients are transferred to an optometrist-led glaucoma monitoring scheme. Patients are given a choice from a list of local optometry practices so they can be treated close to home which could save travel time by up to 2 hours
  5. At the initial optometry appointment, if there are questions in relation to changes to the status of the patient’s eye health condition, the patient is followed up at 3-6 months; for stable patients, the follow up is 12 months
  6. If a patient’s condition worsens, the optometrist refers back to the HES
  7. Other areas, such as North East Essex, have supplemented this process with virtual consultant review as an intermediate step to help patients avoid unnecessary travel
  8. If the patient remains stable, they continue to be monitored within the stable glaucoma monitoring scheme.

References

12. Association of Optometrists, Voice of Optometry Survey 2023
13. Baker H, Ratnarajan G, Harper RA, Edgar DF & Lawrenson JG. Effectiveness of UK optometric enhanced eye care services: a realist review of the literature. Ophthalmic Physiol Opt 2016; 36: 545–557
14. Broadway DC, Tibbenham K. Tackling the NHS glaucoma clinic backlog issue. Eye (Lond). 2019 Nov;33(11):1715-1721
15. OT Insights report, October 2023