Optometrists will still be able to monitor already diagnosed ocular hypertensives and suspect primary open-angle glaucoma patients provided they can perform and interpret a number of clinical techniques including Goldmann applanation tonometry.
The National Institute for Health and Clinical Excellence published its clinical guidelinesthis week. Entitled 'Glaucoma - diagnosis and management of chronic open angle glaucoma (COAG) and ocular hypertension (OHT)', the guidelines aim to improve the effectiveness of care for glaucoma suspects and patients. They recommend that patients with suspect optic nerve damage or repeatable field defects be referred, as is currently the case in optometric practice. Diagnosis of OHT and suspected COAG and the formulation of a management plan, such as when to review, needs to be carried out by a suitably trained healthcare professional with 'a specialist qualification (when not working under the supervision of a consultant ophthalmologist) and relevant experience'.
The guidelines look at the most effective strategies to adopt in terms of treatment and regularity of reassessment. The implication is that anyone suspected of IOPs over 21mmHg or of any glaucoma sign would require referral to a specialist practitioner.
At present the College of Optometrists provides the Diploma in Glaucoma specialist qualification. The requirement for this qualification was mentioned in the draft consultation document available online since September last year.
In one of two clauses (additional to the consultation document) on the organisation of care, the new guidelines state that 'people with a confirmed diagnosis of OHT or suspected COAG who have an established management plan may be monitored (but not treated) by a suitably trained healthcare professional with knowledge of OHT and COAG, relevant experience and ability to detect a change in clinical status'.
The guidelineslist the techniques a practitioner needs to be able to undertake and interpret- Goldmann applanation tonometry, standard automated full threshold perimetry, anterior slit lamp, slit lamp BIO, and Van Herick anterior depth assessment.
Practices without Goldmann or the ability to undertake automated threshold field testing would not be advised to assess known OHT or glaucoma patients as another addition to the consultation document stated 'healthcare professionals who diagnose, treat or monitor people independently of consultant ophthalmologist supervision should take full responsibility for the care they provide'.
Dr Paul Spry, guideline developer and consultant hospital optometrist, said 'High street optometrists will have an important role to play in identifying people at higher risk, and potentially in managing both people with glaucoma and those at risk of glaucoma. The guidelines give formal recognition that suitably trained non-medical health care providers, including high street optometrists, are an appropriate group of professionals for taking care of certain categories of glaucoma patients.'