The Association of Optometrists (AOP) has reiterated its advice on the NICE glaucoma guidelines as a result of rumours that it would change the advice in November and referral rates would return to pre-NICE levels.
Assuring its members that there is 'no prospect of change' in its advice, the AOP said it had been contacted by optometrists across England and Wales to report the claims which were being made by local ophthalmologists.
It repeated that OOs should refer patients with intraocular pressures (IOPs) of 22 mmHg or over 'until such time as your primary care trust (PCT) or local health board (LHB) funds an enhanced service to repeat IOPs using Goldmann (applanation tonometry)'.
Revealing that some PCTs and LHBs are instructing hospitals to reject all referrals based on pressures between 21 and 25 mmHg alone, the AOP also advised OOs what to do if their PCT or LHB rejected their referrals. It recommended that in such cases OOs make clear notes of patients' records and then recall patients at the usual interval for their next sight test. It also advised in such cases that OOs explain to patients what is happening as well as making referrals via the patient's GP so it would then be the GP's task to find an alternative source for the required investigations.
Following consultation with a Scottish QC about the relevance to Scottish practitioners of the NICE guidelines, the AOP and the Federation of Ophthalmic and Dispensing Opticians have also advised all Scottish OOs to refer all patients who have repeated IOPs over 21 mmHg for formal diagnosis of ocular hypertension. The bodies said that in doing so OOs would be helping protect themselves from the risk of civil action taken by a patient from allegations which could be made at a GOC fitness to practise hearing.
The bodies urged Scottish OOs to heed the guidelines because of their value as the latest evidence-based clinical guidelines developed by a panel of experts in this field. The same advice was subsequently issued by both bodies to OOs in Northern Ireland.