Standards & Guidance

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.

Diabetic eye disease is very common and there is a national screening programme to detect and refer treatable diabetic retinopathy to hospital eye services. The diabetic retinopathy (DR) standards in this document apply to how the hospital service provides care and interacts with the community and screening services to ensure safe care and adherence to national guidelines. The document should be read in conjunction the quality standards for medical retina services.  

Disorders of the external eye are very common (blepharitis, conjunctivitis, dry eye, etc.) and if not severe are largely dealt with in primary care, primary care ophthalmology, and general ophthalmic services. Corneal and external disease standards in this document is apply to care of the common conditions at the severe end of the spectrum and of more serious or unusual conditions such as corneal dystrophies, conditions requiring transplantation, vernal keratoconjunctivitis and cicatrising disorders which are more appropriately managed in a dedicated corneal and external eye disease service.

Cataracts are very common and, if not severe enough to require surgery, are largely dealt with in primary care, primary care ophthalmology, and general ophthalmic services. Cataract care standards in this document apply to the surgical pathway and are mainly aimed at providers of operative care

Adnexal disease standards in this document apply to care of the common conditions at the severe end of the spectrum and of more serious or unusual conditions such as orbital and eye lid tumours, lacrimal surgery and major eyelid surgery which are more appropriately managed in a dedicated adnexal disease service.

This quality standards document applies to urgent and emergency secondary ophthalmic care, and how that links up to community and primary care, to ensure safe care and adherence to national guidelines.