A couple of years ago, Amanda Jones wrote about the glaucoma scheme in Manchester involving optometrists. Here she updates us as to the progress made.
The OLGA (optometrist-led glaucoma assessment) scheme was set up at Manchester Royal Eye Hospital (MREH) two years ago. Over 30 per cent of Hospital Eye Service (HES) outpatient appointments are for glaucoma follow up. The aim of OLGA is to manage glaucoma patients within the HES who are considered stable and low risk, therefore freeing up consultant-led outpatient appointments for new referrals and complex cases.
Reminder of OLGA Service
The clinics are run independently from the normal consultant-led clinics, although medical input is always available, should an emergency occur, ie sudden increase in IOP or retinal detachment.
Patients are referred into the service by their consultant or treating physician. Once in the service, patients receive a full work up. This includes:
Patients referred to the OLGA clinic remain the responsibility of the referring consultant. Patients are referred back to the referring consultant if:
At present, approximately 10 per cent of the patients seen within OLGA require referral back to their consultant. Often this is for non-glaucoma related pathology eg BRVO, retinal holes/tears and most commonly cataracts requiring surgery (Figure 1). Patients who are stabilised may be eligible to be referred back to OLGA in the future.
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| Figure 1. Reasons for the 10% of referrals out of OLGA back to consultant ophthalmologist |
Community OLGA
Recently we have expanded the scheme to provide OLGA clinics in a community setting to improve the accessibility of the service to patients. The patients remain under the care of MREH, but are reviewed away from the main hospital site. The first site covers north Manchester and is situated in a large medical centre which has a specialist interest in ophthalmology. The second site is at a new, small, day-treatment hospital located south of the MREH. This hospital caters only for outpatient cases and has excellent car parking and transport links.
The feedback we have received so far has shown that the patients are very happy to go to clinics nearer to their home. They receive exactly the same service as they do within the main OLGA clinics at MREH. At both locations there are medical personnel available to help in an emergency eye situation, and the MREH has a 24-hour emergency eye centre that we can refer to if necessary.
OLGA Staff Profile
Since expansion of the OLGA scheme we now have two full-time optometrists who have been fully trained to review and manage glaucoma patients. There are also two full-time glaucoma technicians who undertake visual field analysis and digital photography.
OLGA Patient Profile
There are over 1,500 patients on our database and we have completed more than 4,000 patient visits. The inclusion criteria for OLGA allow us to monitor stable, 'low risk' glaucoma patients of all types. They consist mainly of primary open-angle glaucoma (POAG), ocular hypertension (OHT) and glaucoma-suspect patients. We also see stable closed-angle glaucoma, normal-tension glaucoma (NTG), pseudoexfoliation syndrome and pigment dispersion syndrome as shown in Figure 2.
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| Figure 2. Profile of OLGA patients by diagnosis |
Most patients within OLGA are being treated with a single topical medication. Most commonly this will be a prostaglandin analogue, closely followed by beta-blockers. Patients requiring two or more topical medications are less likely to be stable, as compliance is often an issue in these cases.
OLGA Feedback
We are currently undertaking an audit of the service and this will include a patient satisfaction questionnaire. The preliminary results of this questionnaire show that the patients are very happy with the OLGA service. They particularly like the one-stop strategy and that they see the same members of staff at each visit. The consultants at MREH seem to have welcomed the OLGA facility and we have a steady stream of referrals into the system. This has been helped by the low referral rate out of the service and reflects the fact that we have well-trained staff and the correct inclusion criteria.
Recently, the community OLGA project was nominated for the Greater Manchester NHS Awards and was shortlisted with two other projects for the 'long-term conditions' award.
In conclusion, the OLGA service has proven to be successful at managing stable and low-risk patients within the HES without them needing to see a doctor. The success of the community OLGA scheme has not been established, but early signs are that it is very popular with patients.
The strategic health authority are very interested in how the community OLGA project works out as it may be a model for other two-tier services.
Acknowledgements
The author thanks Cecilia Fenerty, Fiona Spencer and Joanne Marks for their advice and help in writing this article.