Optical Groups' Cautious Welcome For NICE Glaucoma Guidelines, UK

Main Category: Eye Health / Blindness
Article Date: 26 Apr 2009 - 3:00 PDT

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The optical professional and representative bodies have welcomed NICE's development of national guidelines on the diagnosis and management of chronic open angle glaucoma and ocular hypertension. The new guidelines provide clarity for all clinicians involved in the diagnosis and treatment of glaucoma, however we do have concerns about implementation.

The guidelines give clear and precise recommendations for the diagnosis, monitoring and treatment of chronic open angle glaucoma (COAG) and ocular hypertension (OH), however when implemented, they will place a growing burden on the Hospital Eye Service (HES). The new guidelines are also likely significantly to increase the numbers of diagnostic outpatient referrals.

Optometrists and optical practices are well placed and willing, with appropriate training, to take on much of this work in the community. They could offer high-quality clinical services combined with greater access and convenience but without long waiting times.

A key recommendation of the new guidelines is that patients should be formally diagnosed by a healthcare professional with a specialist qualification using techniques which few optometrists currently perform (applanation tonometry, gonioscopy and pachymetry). In order to comply with the new guidelines, optometrists will have to refer these patients to a specialist for a formal diagnosis and monitoring. This would normally mean the patient would need to be referred to hospital rather than being seen in the community.

Geoff Roberson, AOP Professional Advisor: "While the guidelines provide much-needed clarity on the diagnosis and management of glaucoma, implementation of the guidance will mean hundreds of thousands of additional hospital visits, most of which will be unnecessary. Optometrists are well- placed to provide a solution to this problem, with appropriate training."

This would represent an increase of 10% over the 5 million ophthalmic outpatients episodes provided in 2007-8. The HES is a highly specialised part of the eye care sector but it will struggle to cope with such a large increase with inevitable consequences for waiting lists and appointment intervals. It may that under the Any Willing Provider programme ophthalmologists working in the community would be able to take on some of any extra workload but this will probably not solve the problem.

However such a sudden influx of lower risk, visually normal patients is also likely to disrupt and displace the care of other patients (some of whom will be suffering from other eye conditions which require urgent treatment) with a consequent serious risk of significant disease progression and visual impairment.

We call on the Department of Health and the NHS to enter negotiations urgently with the optical professions at both national and local level to agree how the NICE guidelines can be successfully implemented with the least disruption to current patient services.

Issued by - The Association of British Dispensing Opticians, The Association of Ophthalmologists, The Association of Optometrists, The College of Optometrists, The Federation of Ophthalmic and Dispensing Opticians, The General Optical Council.

Source
The General Optical Council

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