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Eyes and Vision

Glaucoma

Background

Glaucoma is one of the main causes of blindness in the UK and is the commonest reason for recurrent attendances (25%) in Ophthalmological departments in the UK. Furthermore, studies from our centres have shown that some deprived groups in the community are much more likely to go blind from glaucoma. Recent national guidelines for glaucoma and ocular hypertension (raised pressure without damage) have resulted in a marked increase in patient referrals (up to 20%). Current provision of glaucoma care in the NECLES region differs in terms of access to care, barriers to uptake of care, and involvement of non-ophthalmologist personnel with the diagnosis and management of care of glaucoma suspects and established glaucoma cases.

Within the NECLES region there are several centres which have tested different forms of glaucoma service design and modes of training but as yet there is no coordinated approach to detection, referral, and different ways of management or 'shared care' of users suspected or diagnosed with glaucoma.

First Wave of HIEC work in Glaucoma

Project Title: Establishment of the optimum pathway for Glaucoma refinement

Aim: To determine the optimum pathway for referral of patients suspected to have glaucoma from primary care, in terms of cost-effectiveness and patient experience, by evaluation of existing models in the UK.

Methodology: Numerous glaucoma referral refinement schemes are in operation nationally. Little exists in the form of evidence of how effective these schemes are in relation to cost-effectiveness as well as patient satisfaction.

In the recent Summit meeting of the Royal Colleges of Ophthalmologists and Optometrists, it was concluded that accredited and appropriately trained optometrists could play an increasingly important role in glaucoma referral refinement and diagnosis. The most efficient model in which optometrists are to be utilised is not understood.

NECLES Eyes and Vision are therefore performing an evaluation of 5 schemes already in practice. Sites include Huntingdon, Nottingham, Manchester, Gloucester and Essex.

Outcome Measures:

· These will include cost analysis both for the NHS as well as for the patient
· Number of glaucoma referral to hospital eye services
· Reduction in false positive referrals
· Patient satisfaction surveys

The results of this will enable diffusion of best clinical practice within the NECLES region, many of which do not have any referral refinement schemes in place.

Contact us:

Gokulan Ratnarajan, Fellow, Eyes and Vision

Professor Rupert Bourne, Pathway Facilitator, Eyes and Vision

Robyn Hudson, Managing Director, NECLES HIEC