Primary Care Ophthalmology

Glaucoma and Primary Care

Much has been written in the last 5 years about the desirability of managing in primary care settings conditions which have traditionally required hospital care. The major driving force behind plans to shift care from hospitals to primary or community care settings has been a belief that this will save money, though to some extent it is an attempt to counterbalance the increasing tendency for the care of complex conditions to be concentrated in small numbers of specialised units.

On the face of it, primary open angle glaucoma is an attractive condition for a shift from secondary to primary care. It is common, it is increasing in prevalence, many hospital eye departments struggle to keep pace with the demand for appointments despite the fact that many patients require monitoring only once or twice a year, and the equipment for detecting and monitoring it is widely available in community optometric practice.

However, glaucoma remains a challenging group of conditions to treat. Over-detection or over-treatment has a high economic cost. The price of under-detection or under-treatment is preventable irreversible loss of vision. There is no agreed definition of "stable glaucoma", and yet the early detection of progression is very important. Central to this is bespoke treatment planning based on careful assessment of individual risk factors.

The documents in this section are the result of a research project commissioned in 2007 by the Royal College of Ophthalmologists. The original brief was to produce an account of the evidence base for the provision of care for glaucoma in a primary or community care setting, assuming a "medically led, multiprofessionally delivered" model of care. The result of the project is a very comprehensive evidence-based review of glaucoma which will provide many useful resources for anyone involved in planning glaucoma care services.

The author, Dr Samya Riad is an ophthalmologist with a longstanding interest in primary care ophthalmology.

Richard Smith
June 2008

Glaucoma Study Part 1
Glaucoma Study Part 2


Page Updated: 4th July 2008 (SAF)