Ongoing glaucoma care is delivered in a wide range of environments, by several professional groups and with differing levels of training, accreditation, experience, and supervision provided by consultant ophthalmologists. Multiple models of care have evolved across the NHS. They range from classical consultant-led face to face outpatient clinics in hospital utilising a multidisciplinary team to ‘virtual clinics’ with decision making remotely based on diagnostic data to ‘shared-care’ or ‘co-management’ with primary care optometrists. It is crucial that we empower the whole multidisciplinary ophthalmic team in primary and secondary care to safely contribute to glaucoma care, to increase capacity and thereby reduce the backlogs which put patients at risk of permanent and avoidable sight loss and improve the patient experience. This needs to be done based on robust risk stratification.
The UKEGS/RCOphth GLAUC-STRAT-FAST Glaucoma Risk Stratification Tool (2020) provides guidance on how patients with glaucoma-related conditions can be risk stratified based on their lifetime risk of developing visual loss.
This complimentary document summarises existing guidelines to show how currently available training and qualifications enable Health Care Professionals (HCPs) to deliver care for patients with different categories of GLAUC-STRAT-FAST risk. Current guidelines and qualifications relate specifically only to some of these risk categories. The design of care pathways will need to consider the competences available in the local workforce and the degree of consultant / hospital ophthalmic team supervision, and interpretation of the recommendations within a local clinical governance framework with multidisciplinary clinical professional leadership. This will enable the delivery of high-quality care using the wide range of professional skills available, in current and innovative service models.