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Leading the Way in Glaucoma Services

Glaucoma

1 August 2023

A Hidden Threat

Since the pandemic when routine eye testing in the community remained significantly restricted for an extended length of time, NHS eye care services have been dealing with the combined pressures of a historic backlog coupled with constant newly emerging demands. Not surprising, then, that given the current length of waiting lists, more and more eye care practitioners are concerned about a potential ‘tidal wave’ of avoidable sight loss owing to  glaucoma.

How We Are Addressing the Challenges

In an ongoing effort to improve glaucoma care across England, Primary Eyecare has emerged as a  key facilitator of comprehensive glaucoma services through our network of optometry practices. With a focus on referral filtering and disease monitoring, the organisation has partnered with local systems (hospitals and optometry practices) to deliver tailored pathways that support secondary care ophthalmology, ensuring the best possible patient outcomes.

Central to our optometry glaucoma services is the Glaucoma Enhanced Referral Service (GERS – also known as Enhanced Case Finding), which has been successful in reducing false positive referrals. By employing sophisticated screening techniques, false alarms are minimised, allowing our practitioners to prioritise and provide efficient care for those who genuinely require immediate attention.

To ensure we maintain a patient-centric approach, we support the autonomous monitoring and virtual reviews for individuals with ocular hypertension and glaucoma, depending on their risk profile. Flexible and agile, we can adapt to varying patient needs, scaling our services up and down as the local system requires. This will allow us to foster genuine integration within the healthcare system.

Furthermore, with glaucoma continuing to be a leading cause of irreversible blindness, we hope that our efforts to enhance primary and community service pathways for individuals at risk of glaucoma is going to ensure a brighter future for countless individuals across England.

Showcasing Our Integrated Transformation in Action

One of our glaucoma optometrists, Tom Mackley, who is also an optometrist at Lancashire Teaching Hospitals NHS Foundation Trust, was recently invited to give a presentation as part of an online training event called Glaucoma Update aimed at specialist ophthalmologists in the Midlands. The overall aim of the event was to give delegates on the very latest developments in glaucoma management.

Entitled, ‘Glaucoma in Primary Care Today, Tom’s session explored current trends in changing optometry practices relating to glaucoma diagnosis and treatment. Additionally, he highlighted the Glaucoma Enhanced Referral Service (GERS) which we support delivery of in 28 former CCG areas, clocking up some 5,865 patient facing episodes in 2022 – 2023 with a deflection rate away from hospital of almost 60%.

Summarising how we are delivering integrated transformation in glaucoma care in practical and quantifiable terms, Tom explains:

‘Primary Eyecare’s Glaucoma Services include both referral filtering and disease monitoring.  In both cases we work with local systems to deliver the pathways they need to support secondary care ophthalmology.

Our Glaucoma Enhanced Referral Service (GERS) has a proven track record in reducing false positive referrals. Ocular hypertension and glaucoma monitoring are being delivered autonomously or through virtual review, depending on the case risk profile and available workforce competencies.

Either way, our systems provide a robust governance structure, as well as streamlined payment processes, electronic record keeping, failsafe mechanisms, performance monitoring and auditing.

Thanks to our close partnership working with Local Optical Committees LOCs), we can collaborate with primary care leaders in each place to deliver genuinely integrated transformation in glaucoma care.’

Currently, Primary Eyecare works with 14 NHS Trusts around England to deliver glaucoma detection and treatment services around England. A consultant ophthalmologist with glaucoma speciality provides oversight and expert opinion for all pathways where needed and glaucoma specialist optometrists deliver virtual reviews where required as well as clinical leadership.

Glaucoma: Some Key Statistics

Over 700,000 people in the UK have glaucoma – but approximately half of them are unaware. Here are the latest statistics on how the condition is impacting patients and resources globally:

  • Glaucoma accounts for more than 20% of outpatient appointments in hospital eye care (ref: College of Ophthalmologists. (2021). Response from The Royal College of Ophthalmologists to the HEE Strategic Framework Call for Evidence)
  • Over 2 million people are at risk of vision loss owing to glaucoma. Right now an estimated 1,390,000 people are living with ocular hypertension and a further 708,000 living with glaucoma (ref: National Eye Health Epidemiological Model (NEHEM)(2013). Data and models by Public Health Action Support Team, published by Local Optical Committee Support Unit)
  • The Royal College of Ophthalmologists anticipates a 44% increase in demand for glaucoma services by 2035 (ref: Royal College of Ophthalmologists. (2017). The Way Forward)
  • Close relatives of glaucoma patients are up to ten times more likely to develop the condition (ref: Okeke C. (July, 2016). Familial Glaucoma Risk: Spreading the Word. Review of Ophthalmology)
  • Glaucoma is the leading cause of irreversible blindness worldwide, yet many people don’t know they have it (ref: National Institute for Health and Care Research (NIHR). (2020). Glaucoma patients most at risk of sight loss)
  • People of African-Caribbean origin have about a four-times higher risk of primary open angle glaucoma compared to those of European origin. People of east Asian origin are at higher risk of developing primary angle closure glaucoma (ref: Glaucoma UK)

What is Glaucoma?

Glaucoma is the name given to a group of eye conditions where the optic nerve at the back of the eye is damaged. It is often linked with raised pressure within the eye.

When the nerve is damaged, it can start to cause problems with the peripheral (side) vision and because it is a progressive condition, if left untreated can cause permanent damage. With early treatment, further damage to vision can be prevented.

The condition often happens in both eyes, although sometimes can affect one eye more than the other. Incurable and chronic in nature, glaucoma treatment focuses on reducing the pressure levels in the eye, preserving as much existing vision as possible, rather than restoring lost eyesight. Once diagnosed, people with glaucoma need lifelong monitoring to manage their condition and to prevent it from getting worse.