Primary Care Ophthalmology

Primary care ophthalmology has been defined in a variety of ways, but for this purpose, the term is used somewhat loosely and refers to services which provide first-contact care for patients presenting with eye problems including first-contact care in community optometric practice where this is provided by a doctor.

A small number of GPs have a specialist interest in ophthalmology and undertake ophthalmology consultations in their practice, though most GPs refer all but the most minor eye problems. Use of the slit lamp is a core competency for optometrists, and many optometrists will treat minor eye conditions without onward referral.

Primary care within the hospital eye service encompasses eye casualty services and urgent referral clinics. In some hospitals, elective referrals that appear unlikely to require onward referral to a sub-specialty service are also seen in what are termed primary care clinics.  Some hospitals have one or more consultants with a specific remit to lead a primary care ophthalmology service, whilst in others, the primary care clinics are staffed by specialty doctors and ophthalmologists in training with cover from a consultant ophthalmologist.

Primary care ophthalmology outside the hospital setting is commissioned in a variety of ways. Providers include GPs with a specialist interest, hospital-based ophthalmologists, independent healthcare organisations which employ ophthalmologists and ophthalmic medical practitioners. Services may include optometrists or nurses with extended roles.

Ophthalmic medical practitioners (OMPs) are ophthalmologists who conduct NHS sight tests in community optometric practice. Some also conduct primary care ophthalmology clinics as independent practitioners.

The range of conditions that are diagnosed, treated and discharged from primary care ophthalmology clinics without onward referral varies depending on the experience of the ophthalmologist and the facilities available in the setting where the clinic takes place. Typically, this includes minor trauma, minor red-eye conditions, uncomplicated iritis, and uncomplicated posterior vitreous detachment, for example.

Almost all ophthalmic urgent referral services are very busy and constantly struggle to stay abreast of demand. The reasons for what appears to be inexorably rising demand are unclear.