The COVID-19 pandemic has seriously affected the provision of eye care in primary and secondary care. Measures currently in place to protect people from acquiring the infection will undoubtedly lead to vision loss that, in normal circumstances, would have been preventable.
The Royal College of Ophthalmologists and The College of Optometrists are working together to minimise the risk of visual loss by maintaining essential eye care in hospitals and the community. This will require good communication between optometrists and their local eye departments, and local funding arrangements reflecting the additional work being carried out in optometry practices. This work will have an immediate benefit for patients, and pave the way for a more integrated eye care service when normal service resumes.
The management plan is based on two key principles that define the overall strategy. Operational details of how the strategy is delivered will vary across the four nations, reflecting pre-existing eye service arrangements, local commissioning agreements, and the service capacity available.
Both Colleges will be working to support national organisations with the development of more detailed arrangements.
Principles
- Balance risk of significant visual loss and risk of acquiring COVD-19 infection by face-to-face contact
- Direct patient contact should take place with a clinician capable of making appropriate management decisions
Strategy
- Continue to provide care in hospitals for patients known to have conditions putting them at risk of severe visual loss within two to three months
- Hospital ophthalmologists to monitor deferred clinic appointments and provide telephone/written advice to patients
- Provide consultant led and triaged A&E services for emergency and urgent conditions
- Telephone advice for less urgent and chronic conditions. This can be done by either hospital eye departments or optometrists who are able to liaise with both primary and secondary care colleagues
- Use of existing primary care optometry services to see patients who have urgent conditions that can be diagnosed and treated within primary care, in conjunction with hospital-based ophthalmologists as required. View this flow chart for details.
Communication
Good communication between primary and secondary care will determine the success of this plan. Hospital eye departments should provide direct telephone access to an experienced clinician. Optometry practices should establish contact with their local eye departments to discuss what support they can provide for patients. Local prescribing arrangements will need to be put in place.
Management of patients whose Hospital Eye Service (HES) appointment has been postponed
During the pandemic, an estimated 80 to 90% of routine HES outpatient activity will be postponed. This will primarily affect patients with chronic eye diseases such as glaucoma, diabetic retinopathy and age-related macular degeneration. Ophthalmologists are making individual risk assessments based on the likelihood of patients suffering significant visual loss if their face-to-face appointment is deferred for a period of three to six months.
Patients at high risk will continue to be offered an appointment. Those at lower risk are receiving advice by telephone and letter, and are being asked to contact their eye department if they have any concerns. There may be local arrangements in place that formalise the role of primary and secondary care providers in managing some patients.
Some HES patients may seek help from their optometrist if they have concerns. In such circumstances, if no local arrangements exist, optometrists should:
- Encourage patients to contact their eye department. This will allow their concerns to be assessed against their ophthalmology records
- Give telephone advice where appropriate
- Only arrange a face-to-face assessment if it is clearly in the patient’s best interests and, ideally, in discussion with the patient’s eye department