Standards & Guidance

This guidance is for the commissioning of emergency eye care in England for adult patients.

This document, based on published evidence and consensus expert opinion, is designed to indicate how EMRs can be expected to best support the aims of the Royal College and its members in providing high quality ophthalmic care.

This document intends to provide a glossary and basic introduction to the multiple facets of healthcare informatics and provides references for further reading.

This standard incorporates the key requirements of NICE guidance for adult cataract surgery to prevent wrong intraocular lens (IOL) insertion and never events in cataract surgery, and expands on these with evidence based and expert consensus views on all aspects of IOL related safety in cataract surgery.

This document gives commissioners a checklist for quality standards that the RCOphth has developed for ophthalmology services across the UK. This can be used to inform discussions and provide an assessment of the quality of clinical services provided.

Disorders of the retina requiring a surgical approach are common (retinal detachment, macular hole, epiretinal membrane, severe diabetic retinopathy etc.) and care is largely delivered in the secondary care setting although cases may be identified in primary care, primary care ophthalmology, and general ophthalmic services. Vitreoretinal (VR) service standards in this document apply to the care of these conditions which are most appropriately managed in a dedicated VR service.in the hospital setting.

Neuro-ophthalmic disease standards in this document apply to care of the common conditions at the severe or acute end of the spectrum, those requiring invasive procedures and more serious or unusual conditions such as posterior uveitis or unusual retinal vasculopathies, which are more appropriately managed in a dedicated neuro MR service. Some conditions are appropriately managed within the neuro-ophthalmic eye clinics such as ocular motility disorders, eyelid disorders, chronic optic neuropathies including selected genetic disorders, posterior uveitis or retinal vasculopathies. Others require targeted co-management with neurology, neurosurgery, diagnostic and interventional radiology, clinical neurophysiology, and neuro-rehabilitation: these services are located within a Clinical Neurosciences Centre where ready access and consultant-led cross –specialty liaison is required.

Disorders of the retina which are treated non-surgically are very common (age related macular degeneration, diabetic retinopathy, retinal vascular occlusions etc.) and, if mild or long standing, may be dealt with in primary care, primary care ophthalmology, screening services and general ophthalmic services. Medical retina (MR) disease standards in this document apply to care of the common conditions at the severe or acute end of the spectrum, those requiring invasive procedures and more serious or unusual conditions such as posterior uveitis or unusual retinal vasculopathies, which are more appropriately managed in a dedicated MR service.

Glaucoma and ocular hypertension, glaucoma suspects, and those with risk factors for glaucoma are very common and, if stable or low risk, may be dealt with in primary care, primary care ophthalmology, and general ophthalmic services. Glaucoma disease standards in this document apply to secondary care services for established glaucoma and ocular hypertension.