Glaucoma and Ocular Hypertension
6 June 2016 RCOphth publishes Commissioning Guide: Glaucoma
Developed using NICE accredited processes the College has worked with stakeholders to produce guidance for commissioning adult-onset glaucoma and adults who are at risk of developing glaucoma. Glaucoma Commissioning Guide Recommendations – June 2016 Final and Glaucoma Commissioning Guide Long June 2016 Final.
A diagnosis of chronic open angle glaucoma (COAG) normally implies a commitment to life-long follow-up. About 9% of people with Ocular Hypertension (OHT) are likely to develop COAG within 5 years. In 2009, NICE published a guideline on the diagnosis and treatment of COAG and OHT and subsequently, quality standards for glaucoma services. NICE has also published information on commissioning glaucoma services.
There are a number of ways in which services for the diagnosis and treatment of glaucoma may be able to improve value for money. Referral refinement schemes which allow community optometrists to repeat intraocular pressure measurements with an accurate applanation tonometer following apparently high readings with a non-contact tonometer reduce the proportion of false-positive referrals to hospital. The establishment of glaucoma / OHT registers assist the efficient planning of services and ensure that patients are being monitored safely. The establishment of shared-care records (whether electronic, or patient-held) opens the way for a proportion of follow up appointments to take place in a community setting while ensuring that patients can still be monitored to NICE standards.
The care of patients with glaucoma has come under great pressure in some areas as hospitals struggle to meet outpatient new-to-follow-up (NTF) ratio targets set by commissioners. This has in some instances led to repeated postponement of “non-urgent” glaucoma follow-up appointments and there have been cases documented where this has resulted in avoidable loss of vision. A College document on New to follow up ratios in ophthalmology outpatient services for long term eye conditions provides an indicative model of the NTF ratio which should be expected in a typical glaucoma service.
Many areas of the country have already been successful in adopting innovative measures to improve value for money in glaucoma services, particularly where there is consistent support from commissioners. The College is working to promote the wider adoption of efficient and cost-effective pathways for the diagnosis and management of glaucoma and OHT.