Community Services. Literature Summary. Minor Eye Conditions

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1 Community Services Literature Summary Minor Eye Conditions Source Summary data from Webstar Summarises data from 6 services using the IT and with simlar outputs episodes; 82.7% handled in primary care Merges satisfaction data. Only the GM services have PROMS type questions which are mandatory: How likely are you to recommend this service to your friends and family? 92% Extremely likely or likely Could we do better? Susan Parker Optometry Today 17th August 2012; pp 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: Outcome Outcomes Count Percentage Discharge % Follow Up % Routine referral direct to Ophthalmology % Urgent referral direct to HES % Routine referral to GP (not for onward referral) % Total % PROMS response Count Percentage Extremely Likely % Likely % Neither Likely or Unlikely % Unlikely % Don't Know % Total % 90% of optometry referral from sight tests judges appropriate. 20% could have been seen within a minor eye conditions service 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.

2 Auditing enhanced eye care referrals Nik Sheen and Sasha Macken Optometry Today 21st September 2012; pp GM Primary Eyecare Ltd HMR MECS Q1 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 Stockport MECS Q3 Report 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; pp Auditing an acute eye pathway Mark McCracken Optometry Today 22nd March 2013; pp pdf 75% of patients managed by optometrists General Comments Across all services: Satisfaction is high. Patients are generally seen in a timely manner.

3 Community Services Literature Summary Repeat Measures Source Summary data from Webstar Summarises data from all services using the IT and with simlar outputs. Outcome 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%

4 Auditing a repeat readings service Dharmesh Patel Optometry Today 28th June audit.pdf Comparison of the effectiveness of two enhanced glaucoma referral schemes David J Parkins and David F Edgar Ophthalmic & Physiological Optics 31 (2011) Repeating pressures an electronic reporting system Trevor Warburton Optometry Today 17th September % of raised IOP deflected by a single repeat. 73% of suspect visual fields deflected by a single repeat 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 89% deflected by Specialist optometrists in an enhanced case-finding service. Cost savings 3.5% c/w HES tariff 77% deflected by 2 IOP repeats Poster update for 12months = 78% deflected. Repeat pressures in Oxfordshire Gianpiero Celino and Paul Jewitt Optometry Today 30th November 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 79.4% deflected by 2 IOP repeats 63.5% deflected by one reading and 49.7% of the remainder by a 2nd reading. Overall deflection rate 81.2% 76% deflected.

5 Community Services Literature Summary Cataract Referral Source Audit of referrals for cataract extraction: are they appropriate? Chris Tattersall, Shona Sullivan British Journal of Nursing, 2008, Vol 17, No 15 Outcome 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 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 fc29388c0ac9f4e87_sharp pdf 62% listed for surgery prior to pilot and 98% during pilot. Evaluation of a new cataract surgery referral pathway JC Park, AH Ross, DM Tole, JM Sparrow, J Penny and MV Mundasa Eye (2009) 23, 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.

6 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 : 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.

7 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 eb5e6513ceb30_warburton 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: 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.

8 Auditing a local cataract referral pathway Stuart Townsend Optometry Today 20th September 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, 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 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.

9 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: Results Questionnaires were sent to 281 participants (whose visual disability a long-term outcome study had been measured at baseline and 3 months) at 18 months postintervention. Barbara Ryan, Jyoti Khadka, Catey Bunce, Helen Court Responses were received from 190 (67.6%) people; 24 were deceased. Selfreported visual disability was significantly reduced (Wilcoxon Signed Rank Br J Ophthalmol 2013;97: (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 : A description of the Welsh service

10 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 : 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 Description of practitioner activity.

11 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 The accuracy of accredited glaucoma optometrists in the diagnosis and treatment recommendation for glaucoma Augusto Azuara-Blanco, Jennifer Burr, Ruth Thomas, Graeme Maclennan, Stephen McPherson Br J Ophthalmol 2007;91: 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. Aim: To compare the diagnostic performance of accredited glaucoma optometrists (AGO) for both the diagnosis of glaucoma and the decision to treat with that of routine hospital eye care, against a reference standard of expert opinion (a consultant ophthalmologist with a special interest in 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.

12 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, Relates to HES optoms and clinics Can a community optometrist-based referral refinement 8 specialist community optometrists scheme reduce false-positive glaucoma hospital referrals without compromising quality of care? The community and Conclusion This referral refinement process can reduce numbers of falsepositive referrals attending the hospital glaucoma service while hospital allied network glaucoma evaluation scheme (CHANGES) RRA Bourne, KA French, L Chang, AD Borman, M Hingoran1 and retaining a relatively high level of examination quality. WD Newsom Eye (2010) 24, 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, 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. [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, 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

13 Community refinement of glaucoma referrals DB Henson, AF Spencer, R Harper and EJ Cadman Eye (2003) 17, 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. The Peterborough scheme for community specialist optometrists in glaucoma: a feasibility study P Syam, K Rughani, SJ Vardy, T Rimmer, A Fitt, T Husain, L McInerney, D Broome, R Driver, R Wormald and S Ramirez-Florez Conclusion Community refinement of suspect glaucoma offers some important benefits over the current referral pathway. Results This study included 1184 new patients seen by specialist optometrists between February 2005 and March A total of 32% of patients were referred on to the hospital, leaving the remaining 68% patients to be seen for 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.

14 Shared care in glaucoma: a national study of secondary care lead schemes in England SA Vernon and A Adair Eye (2010) 24, 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, 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.

15 Community Services Literature Summary Learning Disabilities Source 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: Outcome 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.

16 SeeAbility s current pilot of the LOCSU pathway in the triborough areas of Kensington and Chelsea, Hammersmith and Fulham and Westminster. Interim findings from SeeAbility s current pilot of the LOCSU pathway in the tri-borough areas of Kensington and Chelsea, Hammersmith and Fulham and Westminster show that a 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.