Glaucoma Awareness Week was held between June 26 and July 2, led by Glaucoma UK’s campaign, which shared people’s personal experiences with glaucoma and their diagnosis. This aimed to reach those who were unaware they may have the disease and urged them to book an eye test. Posters were placed on local high street digital screens across the UK, and a podcast was created called ‘Glaucoma voices: real people, real experiences.’
Glaucoma UK’s chief executive, Joanne Creighton, said: ‘Glaucoma UK’s aim is to end preventable glaucoma sight loss, and that starts with raising awareness of the disease through such campaigns. Glaucoma can be symptomless and early diagnosis is key to saving your sight.’
As part of raising awareness within the optical sector, the Local Optical Committee Support Unit (Locsu) produced a case study, ‘Optometry support for long term condition ¬ Glaucoma’, to highlight the essential role primary eye care services provide to reduce the waiting list for glaucoma care.
The case study suggests how more commissioned services can reduce avoidable referrals and improve referral pathways and quality. It advised that intervention is needed to better integrate primary care optometry into glaucoma services.
On the recent Locsu podcast ‘World Glaucoma Week’, clinical director Zoe Richmond (pictured right) said: ‘We know that in the NHS we’re at a crisis
situation, we have an increasing demand and longer waiting list and we desperately need a new model of care to make sure that we meet the needs of all people with glaucoma in a timely way.
‘Those most in need and most at risk of sight loss will continue to need specialist intervention within the hospitals, but those with a lower risk of sight loss can be seen in an alternative way, making better use of the capability on the high street and within optometric practice.
‘Across a large part of England, we already deliver glaucoma referral filtering services. By fully utilising the clinical workforce, core competency optometrists and referral filtering services, as well as optometrists with higher qualifications and experience, we can support our partners within the hospitalised service to manage more people with glaucoma in a timelier way. Within Locsu, we believe that through whole sector working and collaboration we can transform eye care to best meet population need.’
The case study suggested primary care optometry can support secondary care through increased referral filtering services, such as Repeat Measures and Enhanced Case Finding (ECF), to reduce referrals, as well as by monitoring patients who have been diagnosed with stable, low-risk glaucoma or ocular hypertension (known as the Primary Eyecare Glaucoma Service in Greater Manchester).
However, ECF is said to have potential for improved outcomes only when commissioned alongside Repeat Measures, as in isolation the methods have limited benefits.
The case study said glaucoma services in primary care should be co-developed with the hospital eye service, ensuring holistic care with monitoring appointments kept in line with clinical management plans.
Such enhanced referral schemes were shown to be clinically and economically effective, according to reports cited based on use in Greater Manchester and Cheshire in 2011 and 2019.
In Cheshire, over 70% of patients were retained for monitoring within primary care. Repeat Measures enabled over 70% of patients to be discharged without onward referral, thereby reducing avoidable referrals and hospital capacity; and savings of up to 62% compared with HES tariffs were recorded.
In Greater Manchester’s Glaucoma Enhanced Referral Scheme (GERS), it was said to discharge over 47% of referrals without onward referral, and saved an average of £2.76 per patient seen.
Specsavers also campaigned for the event and released data showing it had 30,000 referrals for glaucoma in people aged 40 to 60 years in the last year, which was 30% of all referrals. The multiple has been working with Glaucoma UK to highlight the role of optometrists.
Optometrist Kevin Liu, (pictured left) who was a partner in three Specsavers practices in Altrincham, Sale and Urmston, Greater Manchester, said: ‘GERS helps us to find those patients who may have glaucoma, while improving the quality of the referrals being sent to hospital. Ensuring the right patients are referred into secondary care ophthalmology services optimises the use of resources. This should continue to make life easier for our hospital colleagues and allow them to focus their care on those who need it.’
Liu, who also worked as a clinical performance consultant at Specsavers, said gaining additional qualifications, such as a Professional Certificate in Glaucoma and Independent Prescribing, has been central to the success of the community services, especially during the pandemic.
‘Although glaucoma referral filtering and monitoring services are commissioned more consistently throughout England, eye care leaders are calling for greater integration of care,’ he added.