News

The Joint Working Group, (made up of representatives from the College of Optometrists, The Royal College of Ophthalmologists, the AOP and FODO) have issued NEW guidance on the referral of patients with suspected glaucoma or OHT. The guidance clarifies the referral criteria, including the use of non-contact tonometers, in this context. It relates to asymptomatic patients with suspected glaucoma only. Those with symptoms should be treated according to current protocols and patients suspected of having other previously undiagnosed conditions should be referred as appropriate.

The guidance can be downloaded from:

http://www.aop.org.uk/uploaded_files/joint_working_group_guidance_on_glaucomaand_oht_referral.pdf

The AOP has endorsed this guidance.

Launch of the Cataract Referral Refinement Scheme for those patients requiring cataract surgery, who have a GP in Bristol PCT. Please see the Cataracts Referrals Page for details.

As you will be aware, the NICE Glaucoma Guidance was published on 22^nd April. We are working closely with the PCTs and Secondary Care to develop a paid referral refinement process and hope to be able to announce progress soon. In the meantime, we recommend that you follow the advice issued by the Optical Bodies, which we have re-produced below.

“The NICE guidelines provide a framework for the diagnosis and management of Chronic Open Angle Glaucoma (COAG) and Ocular Hypertension (OHT) in England and Wales. The guidelines require that OHT should be formally diagnosed using gonioscopy before continued monitoring; OHT is defined in the guidance as intraocular pressure over 21 mm Hg.

This, of course, could overwhelm HES departments but our view is that optometrists and optical businesses put themselves at risk unless they comply with the guidelines. It would be helpful for the referral to state that the patient is being referred in accordance with NICE guidelines as having intraocular pressure over 21 mm Hg but without any other signs e.g. normal discs and fields.

We will be obtaining further legal advice on this matter and when that is available we will update you. Until that time, and regardless of any suggested solutions made by your local primary care organisation or local ophthalmologists to continue current practice, for legal defence purposes, it is strongly advised to refer all patients with intraocular pressure over 21 mm Hg to an ophthalmologist.

Meantime we are working with the Department of Health and NHS to find a workable solution to the issues created by the guidelines both for the short and longer term. One obvious solution is for more of this work to be carried out in the community by optometrists in optical practices.”

At present Bristol Eye Hospital is not being funded to assess patients referred solely under NICE guidelines. They will however assess any referral that does not specifically note health discs and full fields or that has intraocular pressure over 25 mmHg.

Those of you practising in South Gloucestershire will have received a letter from NHS South Gloucestershire regarding a revised GOS18 referral form. Whilst, as the letter says, this has been discussed with the LOC, the LOC did not agree to recommend this to optometrists. We would therefore like to make it clear that it is your choice whether to complete this revised form or use the original GOS18 and that there is no specific recommendation from the LOC.

South Gloucestershire pulls out of cataract scheme

Those of you practising in or near South Gloucestershire should also have received a letter confirming that as of 20^th June 2009 South Gloucestershire PCT will be decommissioning the cataract referral scheme, and therefore will no longer pay practitioners for cataract referral refinement. This means that cataract referrals should be sent in the normal way. The PCT have requested practitioners use the revised GOS18; again we would like to make it clear that it is your choice whether to complete this revised form or use the original GOS18 and that there is no specific recommendation from the LOC. However, if a patient has a Bristol PCT GP, then you will be able to refer through the Bristol scheme with payment

A new fast track referral service to Bristol Eye Hospital (BEH) for patients with have retinal conditions requiring immediate treatment has been established.

This has been set up by Claire Bailey and the medical retina team, mainly to get cases of wet ARMD treated as quickly as possible.

The Retina Unit at the BEH has dedicated retina clinics every day of the week Monday to Friday (A&E at weekends). Patients with retinal conditions requiring immediate treatment e.g. recent onset wet ARMD, retinal detachments/tears and sight threatening diabetic retinopathy can be referred directly to them.

This is NOT a service for patients who have flashes and floaters, without any retinal tears. If you wish these to be looked at, please use the urgent care clinic as at present.

The contact details for this service are:

email: sally.mcdonnell@ubht.swest.nhs.uk

ALL other referrals should be managed as per current referral guidelines (see the Resources/Referrals link to the left).

Avon LOC is exploring the possibility of local optometrists undertaking cataract post-operative follow up appointments. If given suitable training, and if an adequate fee was available, would local optometrists be interested in undertaking such work. Please take part in this survey:

Since the launch of the Cataract Referral Refinement Scheme in Bristol South & West, Bristol North and South Gloucestershire PCTs, the number of optometrists who have signed up to this scheme has been quite impressive.

As an LOC, we are aware that there are quite a few optometrists who were unable to make the launch meeting on Wednesday 15th December 2004, and so are currently unable to take part in this scheme.

Elaine Hadwen (Commissioning Manager, Modernisation & Performance for Bristol South & West PCT) is prepared to arrange a further meeting if there is sufficient demand. So if you are currently not signed up to this scheme but would like to join, please e-mail Elaine directly at:

Elaine.Hadwen@bristolswpct.nhs.uk

expressing your interest in attending a second meeting.

If there is any feedback on the scheme and how it is working, please feel free to contact any LOC member; see the Committee Members page for contact details.

Launch of the Cataract Choice at Point of Referral Scheme for those patients requiring cataract surgery, who have a GP in Bath & North East Somerset PCT....please see the Cataract Referrals page.

Launch of the Cataract Referral Refinement Scheme for those patients requiring cataract surgery, who have a GP in Bristol South & West, Bristol North or South Gloucestershire PCTs....please see the Cataract Referrals page.

Soon to be launched Cataract Referral Refinement Scheme...please see the Cataract Referrals page.

URGENT ATTENTION - IOLs fitted by BEH Nov 2001 to Mar 2002

Mike Potts of the Bristol Eye Hospital would like us all to be aware that a batch of IOLs used by the BEH have proved to have a fault, which is causing them to going cloudy. This will hit the press soon as Gloucestershire are recalling all 2000 of such patients. The effect is similar to posterior capsular thickening, but can be seen as a ‘crinkle’ on the front and back surface of the IOL. Please refer any patient back to the BEH, but DO NOT suggest YAG laser, as this will jeopardise a secondary implant.

Also he requested that we refrain from prematurely referring cataracts (especially 6/9s and second eyes) as it is putting an excessive strain on the service. As the wait time for an extraction is now down around 6 months, there is no need to ‘get on the list early’. After April the BEH will be fined £2000 for each cataract that waits over six months from their first appointment, and we all know they have enough troubles at the moment without that!