Solution sought over glaucoma guidelines
The implications of the NICE guidelines which came into immediate effect on April 22, is that anyone with a suspected IOP of over 21mmHg or any glaucoma sign would require referral to a specialist practitioner.
However, guidance notes suggested that optometrists will still be able to monitor already diagnosed ocular hypertensives and suspect primary open-angle glaucoma patients provided they can perform and interpret a number of clinical techniques including Goldmann applanation tonometry.
Responding to the publication of the guidance, a joint statement from the Association of British Dispensing Opticians, the Federation of Ophthalmic and Dispensing Opticians and the Association of Optometrists, warned members that they could be subject to legal action if they failed to abide with the guidance.
'We will be obtaining further legal advice on this matter and when that is available we will update you. Until that time, and regardless of any suggested solutions made by your local primary care organisation or local ophthalmologists to continue current practice, for legal defence purposes, it is strongly advised to refer all patients with intraocular pressure over 21mmHg to an ophthalmologist,' said the statement.
The optical bodies were seeking official intervention to help to resolve some of the issues raised by changes imposed by the guidelines.
'We are working with the Department of Health (DoH) and the NHS to find a workable solution to the issues created by the guidance both for the short and longer term. One obvious solution is for more of this work to be carried out in the community by optometrists in optical practices.'
While welcoming the 'clarity' and 'structure' provided by the new NICE guidance, the College of Optometrists supported the call from the optical bodies for the DoH to open negotiations on the implementation of these guidelines at both local and national level. Failure to hold discussions could see hospital eye services facing an 'unmanageable' burden resulting from the estimated 400,000-500,000 additional referrals per year expected to be generated by the changes.
The College confirmed that it would be conducting a broad-ranging review of all of its higher qualifications, including glaucoma, in the coming months. This would include looking at specialist competencies, training and methods of assessment.
Professor John Lawrenson, chairman of the College's education committee added: 'A fundamental review of the College's higher qualifications is due to take place this year, and the publication of the NICE guidelines has brought glaucoma to the fore as part of this process.'
Meanwhile, the Royal College of Ophthalmologists (RCO) welcomed the new NICE guidelines. It said: 'These guidelines address the need to ensure quality care, based on the latest scientific evidence for diagnosis and treatment, for all patients with the condition.
'It also emphasises the need for screening for those communities at higher risk. It sets the criteria for treatment which will help to ensure that some people are not unnecessarily committed to eye drops for life.
'NICE is to be commended for publishing these guidelines which, on implementation, will benefit very many people who live everyday with glaucoma.'