Bill Harvey: NICE guidelines
Author: Bill Harvey
Another month and some more NICE guidelines. Last year we saw updated guidance on referrals for both cataract and for suspect glaucoma. I noted at the time that, for the glaucoma guidelines, along with the much publicised change to the intraocular pressure cut-off point for consideration of referral from 21mmHg to 24mmHg, there was also the first statement of the usefulness of an OCT analysis. Glaucoma detection is much enhanced by being able to accurately measure changes in the retinal nerve fibre layer and ganglion cell complex thicknesses over time.
Last week we were told of new NICE guidance with regard to the referral of age-related macular degeneration. Many have suggested ‘nothing new here’, but I would argue there are some things immediately worth noting. Firstly, the guidance categorically states that ophthalmoscopy is undertaken with slit-lamp binocular indirect ophthalmoscopy ‘alone.’ Bearing in mind the range in age of patients seen in any one day, surely this is the death knell for direct as the main technique for retinal viewing.
Secondly, people with vision suggestive of AMD ‘should be offered OCT’. This is a common ocular presentation – can a practice really plan ahead without an OCT being available? Thirdly, suspected wet AMD should be referred urgently even if no visual changes are reported. It rather oddly states this is not an emergency referral but needs to be made within one working day. Presumably this means the appropriate secondary centre needs to be contacted within one day and the patient seen as soon as possible rather than the patient be sent over immediately.
Finally, its states that intraocular injection of anti-VEGF may be undertaken by suitably trained health professionals, including optometrists. I know of only a couple currently undertaking this work, but surely this is a nod to another future development for our profession.