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Community Services
Literature Summary
Minor Eye Conditions
Source
Outcome
Summary data from Webstar
Summarises data from 6 services using the IT and with simlar
outputs - 7681 episodes; 82.7% handled in primary care
Outcomes
Discharge
Follow Up
Routine referral direct to Ophthalmology
Urgent referral direct to HES
Routine referral to GP (not for onward referral)
Total
Merges satisfaction data. Only the GM services have PROMS type PROMS response
questions which are mandatory:
Extremely Likely
Likely
How likely are you to recommend this service to your friends and Neither Likely or Unlikely
family?
Unlikely
Don't Know
92% Extremely likely or likely
Total
Could we do better?
90% of optometry referral from sight tests judges appropriate.
Susan Parker
20% could have been seen within a minor eye conditions service
Optometry Today 17th August 2012; pp18-20
http://www.optometry.co.uk/uploads/clinical-audit-series/august17-2012.pdf
Novel optometrist-led all Wales primary eye-care services:
evaluation of a prospective case series
N J L Sheen, D Fone, C J Phillips, J M Sparrow, J S Pointer, J M Wild
Br J Ophthalmol 2009;93:435–438
Results: 4243 (66%) of the 6432 individuals were managed in optometric
practice; inappropriate management was apparent in 1% of individuals. 392
hospital notes were reviewed; 75% exhibited appropriate optometric referrals
to the HES. 87% of individuals travelled less than 5 miles to attend an
optometrist. The net cost of a PEARS/WEHE consultation was a minimum of
£12.
Conclusions: Optometric management within the schemes is acceptable. Good
equity of access was achieved at a relatively low net cost per consultation.
Agreement on protocols for referral to the HES would enhance the schemes.
Count
4864
1093
630
697
397
7681
Count
4907
454
13
5
452
5831
Percentage
63.30%
14.20%
8.20%
9.10%
5.20%
100.00%
Percentage
84.20%
7.80%
0.20%
0.10%
7.80%
100.00%
Auditing enhanced eye care referrals
Nik Sheen and Sasha Macken
Optometry Today 21st September 2012; pp28-32
http://www.optometry.co.uk/uploads/clinical-auditseries/september-21-2012.pdf
GM Primary Eyecare Ltd
HMR MECS Q1 Report
Stockport MECS Q3 Report
80.3% of patients are managed in primary care (optometry 75.7% and GP
4.6%). Most referral reports are good.
78.5% of patients retained in primary care
100% satisfied or very satisfied
83.46% of patients retained in primary care (Optometry 78.63% / GP 4.83%)
99.80% of patients were very satisfied or satisfied.
Stockort MECS referrals audit
70.1% of referrals on to the HES were appropriate
Auditing of a referral refinement service in Hull
79% of patients were managed in primary care (Optometrist 69% / GP 10%).
Liz Greenwood
Optometry Today 25th January 2013; pp24-26
http://www.optometry.co.uk/uploads/clinical-audit-series/jan-252013.pdf
Auditing an acute eye pathway
75% of patients managed by optometrists
Mark McCracken
Optometry Today 22nd March 2013; pp34-37
http://www.optometry.co.uk/uploads/clinical-audit-series/march22-2013.pdf
General Comments
Across all services:
Satisfaction is high.
Patients are generally seen in a timely manner.
Community Services
Literature Summary
Repeat Measures
Source
Outcome
Summary data from Webstar
Summarises data from all services using the IT and with simlar
outputs.
10 services and 6,600 episodes
IOP Deflections at 1st Repeat
6600 cases had a 1st Repeat of IOP
3776 deflected at 1st Repeat of IOP
Deflection rate: 57.2%
IOP Deflections at 2nd Repeat
2416 cases had a 2nd Repeat of IOP
976 deflected at 2nd Repeat of IOP
Deflection rate: 40.4%
Overall deflection rate 72%
Deflections from repeat of fields
583 had a repeat of fields
225 deflected at repeat of fields
Deflection rate: 38.6%
Auditing a repeat readings service
Dharmesh Patel
Optometry Today 28th June 2013
http://www.optometry.co.uk/uploads/clinical-audit-series/june28-audit.pdf
58.42% of raised IOP deflected by a single repeat.
73% of suspect visual fields deflected by a single repeat
Comparison of the effectiveness of two enhanced glaucoma
referral schemes
David J Parkins and David F Edgar
Ophthalmic & Physiological Optics 31 (2011) 343–352
Repeat IOP and or VF: 75% deflected by 1 or 2 repeats or IOP and/or one
repeat of VF. Cost savings 62% c/w HES tariff
Repeating pressures – an electronic reporting system
Trevor Warburton
Optometry Today 17th September 2010
http://www.optometry.co.uk/uploads/articles/ELECTRONIC.pdf
77% deflected by 2 IOP repeats
Repeat pressures in Oxfordshire
Gianpiero Celino and Paul Jewitt
Optometry Today 30th November 2012
http://www.optometry.co.uk/uploads/clinical-auditseries/november-30-2012.pdf
79.4% deflected by 2 IOP repeats
The Intra-Ocular Pressure Refinement Enhanced Service Pilot
Project Evaluation
Dr Kathryn King, Dr Jonathan Ling and Dr Lyn Brierley-Jones
NHS North Tyneside Primary Care Trust
South of Tyne & Wear LOC Audit
63.5% deflected by one reading and 49.7% of the remainder by a 2nd reading.
Overall deflection rate 81.2%
89% deflected by Specialist optometrists in an enhanced case-finding service.
Cost savings 3.5% c/w HES tariff
Poster update for 12months = 78% deflected.
76% deflected.
Community Services
Literature Summary
Cataract Referral
Source
Outcome
Audit of referrals for cataract
extraction: are they appropriate?
Chris Tattersall, Shona Sullivan
British Journal of Nursing, 2008, Vol 17, No 15
Community cataract referral data only appears lacking in their
consideration of patients’ quality of life, which needs to be clarified
prior to a hospital visit – either by better communication with the
community optometrists or by contact with the patient.
Cataract assessment and direct referral: Stockport optometrists 62% listed for surgery prior to pilot and 98% during pilot.
take the initiative
Jack Sharp BA (Hons), MA (Econ), MIHM, Anthony Moriarty FRCS,
FRCOphth, Trevor Warburton BSc, FCOptom and Judith Dixon BSc,
FCOptom
Optometry Today 25th July 2003
http://www.optometry.co.uk/uploads/articles/c255e1b62488b87
fc29388c0ac9f4e87_sharp20030725.pdf
Evaluation of a new cataract surgery referral pathway
JC Park, AH Ross, DM Tole, JM Sparrow,
J Penny and MV Mundasa
Eye (2009) 23, 309–313
Optometry referrals were more likely to contain information relating to
objective visual loss (100% vs 87% and listing rates were higher for optometry
referrals (87% vs 69%)
Conclusions: Optometric direct cataract referrals provide better information
on objectively measured vision and better
delivery of preoperative counselling. Traditional GP referrals contain better
medical history, drug information, and details of personal circumstances.
Rates of surgery were slightly higher with optometric referrals.
Optometrist referrals for cataract and Action
on Cataracts guidelines: are optometrists
following them and are they effective?
S. C. Lash, C. P. Prendiville, A. Samson, K. Lewis, R. Munneke
and B. T. Parkin
Ophthal. Physiol. Opt. 2006 26: 464–467
Conclusion: We recommend that all referrals for cataract should confirm a
detrimental effect on lifestyle and the patient's willingness for surgery, in
addition to confirming cataract as the main cause of visual loss.
Community Services
Literature Summary
Post-op Cataract
Source
Outcome
Post-operative cataract care in the community
Patients were satisfied or very satisfied with all aspects of the service and
The patient's view
convenience of an optometry service. In professional aspects such as the
Trevor J. Warburton BSc, FCOptom
thoroughness of an exam the optometrist rated more highly than the HES.
Optometry today 19th May 2000
http://www.optometry.co.uk/uploads/articles/6e3bc8170177300
6335eb5e6513ceb30_warburton20000519.pdf
Cambridgeshire cataract shared care model: community
optometrist-delivered postoperative discharge scheme
George Voyatzis, Harry W Roberts, Jonathan Keenan, Madhavan S
Rajan
Br J Ophthalmol 2014;98:760–764
Results Over a 23-month period, a total of 1492 of 2461 (60.6%)
Cambridgeshire patients were discharged to the community on the day of
cataract surgery. Complete postoperative feedback was available in
96.85% of these patients. Uneventful postoperative recovery was recorded in
93.77% of patients with 2.95% of patients re-referred. Rates of cystoid
macular oedema, uveitis and raised intraocular pressure were 0.6%, 1% and
0.1%, respectively. No patients had sight-threatening complications in this
study.
Conclusions Postcataract surgery follow-up by community optometrists
provides the advantages of care closer to home and avoids unnecessary
hospital visits for patients undergoing uncomplicated cataract surgery.
Auditing a local cataract referral pathway
Stuart Townsend
Optometry Today 20th September 2013
http://www.optometry.co.uk/uploads/clinical-auditseries/september-20-2013-audit.pdf
Demonstrates the ability to compare providers if data is available to
commissioners.
Cataract surgery and the optometrist
D.J. Muthucumarana, T.J. Rimmer
Eye (2000) 14, 777-778
Conclusion Patients without complications can be discharged to the care of
their optometrist on the first day following cataract
surgery. With good communication between hospital and the optometrist,
better use can be made of available resources.
In 23% of cases there was no feedback, which demonstrates the problem of
trying to base a service on goodwill rather than fees and contracts.
Community optometry working with hospital ophthalmology:
the benefits of working together in a shared care cataract
pathway
W Newsom, U Hussain, Cs Stephenson, and M Hingorani
Optometry in Practice 2013 Volume 14 Issue 2 55 – 60
Post-op data available for 92.4% of patients over a 5-year period.
Discharge on day of surgery for uncomplicated cases (88%) with 4-week check
at optometrist.
Community Services
Literature Summary
Low Vision
I have been unable to locate any reports or audits of low vision services in
England
Source
Outcome
Effectiveness of the community-based Low Vision Service Wales:
a long-term outcome study
Barbara Ryan, Jyoti Khadka, Catey Bunce, Helen Court
Br J Ophthalmol 2013;97:487-491
Results Questionnaires were sent to 281 participants (whose visual disability
had been measured at baseline and 3 months) at 18 months postintervention.
Responses were received from 190 (67.6%) people; 24 were deceased. Selfreported visual disability was significantly reduced (Wilcoxon Signed Rank
(WSR) test: p<0.001) between baseline and 18 months by −0.28 logits (−1.24
to 0.52). This was less than that found between baseline and 3 months; −0.61
logits (−1.81 to 0.02). At 18 months, 79% patients used their LVAs at least once
a week which was not significantly different to that found at 3 months (WSR:
p=0.127).
Conclusions This study provides evidence that the effect of the LVSW persists
over a period of 18 months; disability is reduced from baseline, and use of
LVAs remains high.
A revolution in Welsh low vision service provision
T H Margrain, B Ryan and J M Wild
Br J Ophthalmol 2005 89: 933-934
A description of the Welsh service
The newly established primary care based Welsh Low Vision
Service is effective and has improved access to low vision
services in Wales
Barbara Ryan, Sean White, John Wild, Helen Court and Tom
H. Margrain
Ophthal. Physiol. Opt. 2010 30: 358–364
Results: Following instigation of the WLVS, the number of low vision
assessments increased by 51.7%, the waiting time decreased from more than
6 months to less than 2 months for the majority of people, and journey time
to the nearest service provider reduced for 80% of people. Visual disability
scores improved significantly (p < 0.001) by 0.79 logits and 97.42% patients
found the service helpful.
Conclusions: The extension of low vision rehabilitation services into primary
care identified a considerable unmet burden of need as evidenced by the
substantial increase in the number of low vision assessments provided in
Wales. The new service is effective and exhibits improved access.
Low vision priority
Rebecca John
Optometry Today 9th May 2014
http://www.optometry.co.uk/uploads/clinical-auditseries/may_9_2014.pdf
Description of practitioner activity.
Community Services
Literature Summary
Glaucoma & OHT
Source
Outcome
How SAFE and EFFECTIVE is
community monitoring for glaucoma?
Lewis K A, Davison C R
UK & Eire Glaucoma Society 2013
Aim: To establish how safe patients are in the Bournemouth Shared
Eye Care Scheme (SECS)
• Are they lost to follow up?
• Any significant vision loss whilst under SECS?
and whether SECS is effective in detecting glaucomatous progression.
Conclusions: A paper-based, low technology model of community glaucoma
care, based on simple biometrics (VA, IOP, CDR, & VF) can be safe and
effective.
The accuracy of accredited glaucoma optometrists in the
Aim: To compare the diagnostic performance of accredited glaucoma
diagnosis and treatment recommendation for glaucoma Augusto optometrists (AGO) for both the diagnosis of glaucoma and the decision to
Azuara-Blanco, Jennifer Burr, Ruth Thomas, Graeme Maclennan, treat with that of routine hospital eye care, against a reference standard of
Stephen McPherson
expert opinion (a consultant ophthalmologist with a special interest in
Br J Ophthalmol 2007;91:1639–1643.
glaucoma).
Conclusions: Community optometrists trained in glaucoma provided
satisfactory decisions regarding diagnosis and initiation of treatment for
glaucoma. With such additional training in glaucoma, optometrists are at least
as accurate as junior ophthalmologists but some cases of glaucoma are
missed.
Agreement between specially trained and accredited
optometrists and glaucoma specialist consultant
ophthalmologists in their management of glaucoma patients
JR Marks, AK Harding1 RA Harper1 E Williams1 S Haque2 AF
Spencer1and C Fenerty1Eye (2012) 26, 853–861
Relates to HES optoms and clinics
Can a community optometrist-based referral refinement
scheme reduce false-positive glaucoma hospital referrals
without compromising quality of care? The community and
hospital allied network glaucoma evaluation scheme (CHANGES)
RRA Bourne, KA French, L Chang, AD Borman, M Hingoran1 and
WD Newsom
Eye (2010) 24, 881–887
8 specialist community optometrists
Shared care of patients with ocular hypertension in the
Community and Hospital Allied Network Glaucoma Evaluation
Scheme (CHANGES)
A Mandalos, R Bourne, K Frenc1, W Newsom and L Chang
Eye (2012) 26, 564–567
Conclusions CHANGES freed up capacity within a busy HGS. However,
improvements need to be made regarding non-attendance rates
in the community. The relatively high one-year definite or probable
conversion rate emphasises the importance of the comprehensive review of
OHT patients and of hospital-led virtual supervision to maintain patient safety.
Conclusion This referral refinement process can reduce numbers of falsepositive referrals attending the hospital glaucoma service while
retaining a relatively high level of examination quality.
[so not especially helpful]
DNA rate 14.3%. 12.3% re-referred with 6.1% of those retained in the HES
An economic comparison of hospital-based and communitybased glaucoma clinics
A Sharma, M Jofre-Bonet, M Panca, JG Lawrenson and I Murdoch
Eye (2012) 26, 967–971
A theoretical model of costs which is flawed because it assumes that
optometrists would require the same level of profit as they do for the base
business of spectacle dispensing. This is clearly incorrect as demonstrated by
the number willing to particpate in services at fees the NHS is willing to pay
Community refinement of glaucoma referrals
DB Henson, AF Spencer, R Harper and EJ Cadman
Eye (2003) 17, 21–26
Results The number of suspect glaucoma cases referred to the Manchester
Royal Eye Hospital was reduced by 40%. This figure is close to the percentage
of false-positive referrals measured at Manchester Royal Eye Hospital prior to
the onset of this study. The information accompanying referral has been
improved and the scheme produces a small financial cost saving to the NHS of
approximately £17 per patient.
Conclusion Community refinement of suspect glaucoma offers some
important benefits over the current referral pathway.
The Peterborough scheme for community specialist optometrists Results This study included 1184 new patients seen by specialist optometrists
in glaucoma: a feasibility study
between February 2005 and March 2007. A total of 32% of patients were
P Syam, K Rughani, SJ Vardy, T Rimmer, A Fitt, T Husain, L
referred on to the hospital, leaving the remaining 68% patients to be seen for
McInerney, D Broome, R Driver, R Wormald and S Ramirez-Florez at least their next consultation in the community by the SOGs. The following
levels of disagreement were observed between SOGs and the project lead: on
cup:disc ratio (11%), visual field interpretation (7%), diagnosis (12%),
treatment plan (10%), and outcome (follow-up interval and location) (17%).
Conclusion This study indicates that there is potential for a significant increase
in the role of primary care optometry in glaucoma management. The study
also confirms a need for a significant element of supervision and
advice from a glaucoma specialist. The important issue of cost effectiveness is
yet to be confirmed.
Shared care in glaucoma: a national study of secondary care lead
schemes in England
SA Vernon and A Adair
Eye (2010) 24, 265–269
Conclusion In England, even before the outcome of the Department of Health
shared care pilots had been published, 50% of ophthalmic departments were
running shared care schemes for glaucoma. However, most schemes
contributed only modestly to the overall volume of glaucoma care, indicating
that the majority of glaucoma-related consultations still occur directly with
ophthalmologists. The Royal College of Ophthalmologists guidelines on
gonioscopy are not being followed in almost half of the schemes seeing new
patients.
Of 66 services, 14 appeared to be community optometry services.
Shared care of patients with ocular hypertension in the
Community and Hospital Allied Network Glaucoma Evaluation
Scheme (CHANGES)
A Mandalos, R Bourne K French, W Newsom and L Chang
Eye (2012) 26, 564–567
Conclusions CHANGES freed up capacity within a busy HGS. However,
improvements need to be made regarding non-attendance rates in the
community. The relatively high one-year definite or probable conversion rate
emphasises the importance of the comprehensive review of OHT patients and
of hospital-led virtual supervision to maintain patient safety.
Community Services
Literature Summary
Learning Disabilities
Source
Outcome
Ocular and visual status among children in special
schools in Wales: the burden of unrecognised visual
impairment
J Margaret Woodhouse, Nathan Davies, Aideen
McAvinchey, Barbara Ryan
Arch Dis Child 2014;99:500–504
ABSTRACT
Background/Aims The high prevalence of visual defects among children with special needs is
well reported and guidelines for vision screening are in place. However, recent research has
suggested that vision care for such children is neglected. This study set out to evaluate the
current status of vision screening and eye care in special schools in Wales.
Methods In phase 1, all 44 special schools in Wales received a questionnaire on current
vision screening practices. In phase 2, full eye examinations were conducted with 173 pupils
of five schools with no screening service; the pupils were aged 2–21 years. In phase 3,
feedback about the service was obtained from all schools and from
15 parents whose children took part.
Results In phase 1, vision screening was patchy and inconsistent among the 39 schools
responding. In phase 2, there is a high proportion of pupils (42%) reporting no previous eye
examination. Overall, 17% of the pupils in the five schools presented with low vision (WHO
definition, poorer than 0.3 LogMAR), 50% needed a first-time or updated spectacle
prescription and 51% had some ocular abnormality that was either sight-limiting or
warranted action to prevent risk to sight. In phase 3, school staff and parents reported that
school-based eye examinations were valuable and, for those children with previous
experience, likely to be more successful than clinic-based or practicebased examinations for
this particular population. Conclusions There is an urgent need for a school-based
optometric service for this vulnerable group of children and young people.
SeeAbility’s current pilot of the LOCSU pathway in the tri- Interim findings from SeeAbility’s current pilot of the LOCSU pathway in the tri-borough
borough areas of Kensington and Chelsea, Hammersmith areas of Kensington and Chelsea, Hammersmith and Fulham and Westminster show that a
and Fulham and Westminster.
majority of patients who accessed the service had not received an eye test in the last 2 years;
55% were prescribed glasses (17% for the first time); 33% had a new eye health issue
identified and 29% were referred on to another eye care service. Patients and carer
satisfaction with the service is high.