‘It has to be better for our patients to see someone with four years’ training, and many years’ experience with the eye, who has a slit lamp and possibly an OCT, rather than seeing a GP practice nurse or someone in A&E who may have only a few hours training in the eye.’
This is a direct quote from the Royal College of Ophthalmologists Way Forward project. The project was commissioned by the RCOphth ‘to identify current methods of working and schemes devised by ophthalmology departments in the UK to help meet the increasing demand in ophthalmic services.’ The increasing demand for hospital eye services is not being met and continues to grow, constituting nearly 10% of all outpatient appointments and 6% of the surgery in the UK.
A number of areas are considered specifically; namely glaucoma, cataract, AMD and emergency eye care. There have undoubtedly been major improvements, particularly regarding the first three, with better use of primary care (obviously optometrists are key here) in both referral refinement and follow up. The increased access to OCT is cited as a major step forward and I cannot see how community optometry can plan for the long term without this technology.
Acute referral schemes (MECS, PEARS, ACES) are viewed positively but with a couple of caveats. Firstly, while such schemes are pretty well universal in Scotland and Wales, just 42% of English hospital departments are involved in such schemes. A second point, and one which I know a number of ophthalmology colleagues are concerned about, is that such community schemes may duplicate activity and even introduce an unnecessary extra tier into a care plan.
On a positive note, it looks as if talking is well under way and optometrists are being mentioned. Look out for a report by Nick Rumney of a recent meeting focusing in this area in next week’s issue.