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Ophthalmic Services Guidance

The Royal College of Ophthalmologists is the guardian of excellence in ophthalmology. It aims to set standards in all aspects of ophthalmology to achieve high-quality care and protect patient safety. Ophthalmic services guidance is intended to inform ophthalmologists and those managing eye services how to best provide services, clearly identifying standards of practice to be achieved through adequate staffing levels and skill mix, proper facilities and appropriate resourcing. See also College Quality Standards, which are easy to use self-assessment tools for measuring achievements against subspecialty and specific patient group service standards.

Ophthalmic Services Guidance Description
Ophthalmic Services for Children 2021 This document updates the 2012 Ophthalmic Service Guidance for paediatric ophthalmology. It represents the expert consensus, based on available evidence and national guidance, of the Paediatric Sub-committee of The Royal College of Ophthalmologists (RCOphth) regarding best practice and fundamental standards for children’s ophthalmic services. It should be read in conjunction with the RCOphth Quality Standards for paediatric ophthalmology services and RCOphth principles and generic information to inform commissioning of paediatric ophthalmology services.
Low Vision Guide 2021 It is never easy to tell someone that we cannot offer a treatment for their sight loss, or to offer them registration. However, there are many simple strategies that can be incorporated into the way the ophthalmologist practices – even during the busiest clinic– that will ensure the people we encounter experience a smoother journey into accepting their low vision and living with it. This guide runs through all the steps involved in informing a patient, the services available and advice you can give them.
Cataract Services Workforce Guidance March 2021

RCOphth cataract workforce calculator tool Mar2021

(a video instruction on how to use the calculator tool is embedded in the document)

Cataract Services Workforce Guidance Stakeholder Feedback and Changes Mar2021

The Cataract Services Workforce Guidance provides practical information for hospital staff planning and operating lists to utilise theatre time efficiently and a unique ‘cataract services workforce calculator’ for determining the staffing requirements for different patient pathways to serve the local population needs. It provides detail on number of surgical lists, and the total annual and weekly ophthalmologist sessions needed, taking into account the primary eye care workforce.
Cataract Hubs and High Flow Cataract Lists The Royal College of Ophthalmologists (RCOphth) and Getting It Right First Time (GIRFT) have jointly produced a new document offering guidance and recommendations for setting up cataract hubs and high volume cataract lists, to improve help patient care post-COVID.
Measuring Levels of Harm in an Ophthalmic Setting 2021 Assessing the level of harm can be complex but is an essential part of undertaking an investigation into any incident where a patient has come to harm. Using standard trust risk ratings and consequence categories, which often use mortality as the main indicator of the higher levels of harm, precludes ophthalmology patients being rated at the higher levels of harm which the incident warrants. In this document we have developed a list of patient outcomes and associated consequence categories which aim to help guide the assessment of patient harm for ophthalmology patients.
Eye Drops Instillation by Unregistered Health Care Professionals for use within NHS Ophthalmic Services 2020

Framework for ophthalmic services to facilitate the administration of necessary and appropriate eye drops by unregistered health professionals to patients under the care of the ophthalmic department. It outlines how this is possible and legal within the currently legal and regulatory systems.

Glaucoma Risk Stratification Tool The RCOphth and UKEGS have collaboratively developed a clinical tool for classification of patients with glaucoma into strata of risk for significant future sight loss and an estimate of resource requirement for managing the patient. The tool acknowledges diagnosis, stage of disease, complexity of disease, rate of disease progression, life expectancy, ocular and systemic comorbidities, dependency and socio-economic deprivation. The eye-level classification should be used to stratify patients according to the worse eye which has remaining useful vision, for which the patient is willing to undergo treatment to retain sight.
Genomics Services Guidance 2020 As part of the NHS England Long Term plan there is a major initiative to develop personalised approaches to medicine with delivery of 500,000 individuals offered whole-genome sequencing (WGS) by 2023. Genomic testing in ophthalmology (England) is changing significantly with the introduction of a national directory of approved genetic tests, three appointed laboratory providers of specialised ophthalmic genomic testing and importantly, centralised funding for most rare disease testing. The other three home nations are also at advanced stages of planning in this area. Now it is an opportune time to consider how to integrate genomics into mainstream ophthalmic practice. This guidance provide information on these changes and their implications for ophthalmology.
Measuring follow up timeliness and risk for performance reporting, improvement actions and targeting failsafe procedures in England 2020 Guidance on how risk should be judged within follow-up patients and a risk stratification coding framework. This document also provides guidance to clinicians, commissioners and system administration teams on how to calculate the 25% delay target for ophthalmology and how to submit this to NHS Digital.
Electronic Medical Records – Standards for UK Ophthalmology Services 2018 Standards designed to indicate how electronic medical records can best support the provision of high quality ophthalmic care.
Correct IOL implantation in cataract surgery – quality standard 2018 Quality standard which builds on the NICE guideline for cataract in adults and is based on published evidence and expert consensus. It provides detailed guidance for units how to take all possible precautions to reduce the likelihood of wrong IOL never events.
Prescribing Unlicensed Medicines – A brief guide
Guidance on the use of unlicensed medicines and licensed medicines used outside their product licence (‘off label use’).
Intravitreal Injection Therapy
The aim of this guidance is to provide advice about performing all intravitreal injection therapy (IVT) as safely as possible, whilst supporting the requirement for innovative and efficient models of care to deal with the continuing increase in demand.
Ophthalmology outpatients – safe and efficient processes
This guidance summarises the robust processes required to ensure effective and safe use of resources to deliver ophthalmology outpatient care, in particular ensuring high risk cases are not lost to follow up.
Referral Pathways for Adult Ocular Tumours 2021 Guidance on referral of patients to the nationally designated ocular oncology centres. Referring ophthalmologists should continue to exercise discretion based on the individual clinical presentations of individual patients.
Ophthalmic Imaging Guidance 2021 Provides an overview of current ophthalmic imaging technologies and their clinical applications.  It also provides recommendations on minimum ophthalmic imaging requirements for hospital eye services and related information technology and information governance requirements
Emergency eye care in hospital eye units and secondary care
Provides information on good practice for urgent and emergency secondary emergency ophthalmic care.
Eye Care in the Intensive Care Unit
Advice and information for clinical staff involved in eye care in the ICU to protect the eye in vulnerable patients, identify disease affecting the eye in ITU patients, and specifically those which might need ophthalmic referral and deliver treatment to the eye when it is prescribed. Updated April 2020 with information on regarding the lack of need now to routinely screen all fungal positive patients to avoid unnecessary trips to ITU for ophthalmologists.
Theatre procedures
This document will summarise the processes and staffing required for safe and efficient major ophthalmic surgery.
Theatre facilities & equipment
This document concentrates on the facilities and equipment for provision of major ophthalmic surgery.
Ophthalmic instrument decontamination
Explains requirements for the effective decontamination of re-usable surgical instruments (or other clinical devices used in direct contact with tissues) to minimise transmission of infection.
Ophthalmic pathology
This is based on joint guidance document of The Royal College of Ophthalmologists and The Royal College of Pathologists on the management of ophthalmic pathology specimens
Healthcare informatics
Provides a glossary and basic introduction to healthcare informatics relating to ophthalmology and references for further reading.
Eye care services for adults with learning disabilities
Provides guidance and support to help ophthalmologists provide insightful and quality care for patients with LD. See also the General Medical Council’s interactive learning sessions on  patients with LD on its website.
Managing an outbreak of postoperative endophthalmitis
Advice on the identification and management of an outbreak of post ophthalmic procedure endophthalmitis, concentrating on cataract surgery, but also applicable to other intraocular procedures including intravitreal injections. A summary sheet and check list is included.
Vision Standards for Driving 2019 Advice on issues about driving which frequently concern ophthalmologists in their day-to-day work and to consider the duties of a responsible ophthalmologist, and a responsible driver.
Ophthalmic services for children
Consensus advice on best practice and minimum standards for health services for children with ophthalmic disorders.
Primary Eye Care, Community Ophthalmology and General Ophthalmology


Ophthalmology is now the busiest outpatient attendance specialty. With demand already overwhelming many hospital eye services (HES), innovative approaches for the management of acute and chronic eye disease are necessary to provide safe and sustainable services.  This document developed with the College of Optometrists, outlines the roles of primary eye care and community ophthalmology, the related development of general ophthalmology as a specialty, and how ophthalmic services could be better reconfigured enabling a more comprehensive service by ‘the right person, in the right place’ appropriate for that patient’s condition.
Standards for virtual clinics in glaucoma care in the NHS hospital eye service
This provides advice on how to deliver virtual clinics, a relatively new model of service delivery, in secondary care in glaucoma to help deal with increasing patient numbers. The document reflects the findings of The Way Forward Project and should help to standardise glaucoma virtual clinic provision.
Sustainability in Ophthalmology
Global resources are finite; as this becomes more apparent the concept of sustainability in healthcare is becoming more important. This paper has been created by a group of people from a wide variety of disciplines to inform, guide, provoke thought and offer practical solutions to some of the sustainability issues within ophthalmology.
Management of Retinal Detachment
Advice on the management of acute retinal detachment (advice – requires update).
Delivery of Diabetic Eye Care
(March 2009)
This chapter addresses issues of provision of care for patients with retinopathy referred to the hospital eye service (advice – requires update).


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