Enhanced Case Finding Service for Glaucoma

The aim of this service is to provide an enhanced case finding pathway for patients by level 2 accredited optometrists who have been identified by non-accredited (level 0) optometric practices to have suspected raised IOPs or from the DESP (Diabetic Eye Screening Programme) with signs of possible glaucoma.

By using this pathway, there should be a reduction in false positive referrals, resulting in a lower burden on ophthalmology services, whilst providing care closer to home.

Patient Inclusion criteria

1. Referred by DESP having signs suspicious of glaucoma or
2. Referred by non-GAT accredited optometrists having raised pressures (IOPs) of 24-31 mmHg with no other signs of glaucoma.
3. Will be over 18 years of age.

Clinical measurements for each patient

1. VA.
2. Central visual field assessment using standard automated perimetry (full threshold or suprathreshold).
3. Peripheral anterior chamber depth assessment using van Herrick test or OCT.
4. Goldmann Applanation Tonometry (GAT)
5. Optic nerve head assessment and fundus examination using stereoscopic slit lamp biomicroscopy (with pupil dilation if necessary), and optical coherence tomography (OCT) or optic nerve head imaging if available.

Outcomes

1. Refer: any patient found to have optic nerve head damage and/or visual field defects consistent with glaucoma directly to a specialist glaucoma service for diagnosis and management. This includes the Leeds Community Ophthalmology providers.
2. Repeat IOP/GAT: any patient with IOPs 24-31 mmHg using GAT should have a repeat measurement with GAT on a separate day within 2 weeks.

Outcome: a) refer any patient with 24 mmHg or more on repeat measurement directly to a specialist glaucoma service.

b) discharge any patient from pathway if IOP is less than 24 mmHg.

3. Repeat fields: any patient with suspicious field defects with no corresponding findings suggestive of glaucoma or obvious explanation (e.g. lid or lens artefact, longstanding defects, etc.).

Outcome: a) refer any patient with a repeatable and reliable defect.

b) discharge any patient with no definitive, repeatable, reliable defect.

4. Discharge from the pathway: any patient with no signs suggestive of glaucoma or OHT. They must continue to attend DESP and for their regular sight test.

Paperwork

Referrals from DESP will be accompanied by a copy of the GP’s letter summarising the current clinical status and DR grading.

Optometrists will complete a standard patient record form. Provide reports to GP and to Ophthalmology services when referrals are made preferably using nhs.net. No copy of report to DESP is required.

Prices

Colleague or DESP referral for enhanced case finding – per episode   £55

Repeat GAT   £25

Repeat visual fields   £30

Repeat GAT and visual fields   £40