There are approximately 500,000 patients in England with glaucoma or a related condition (for example, ocular hypertension) who require 1 million hospital eye service appointments each year. Indeed, it has been calculated that one third of all HES appointments relate to glaucoma.
In addition to the patients who are already in the system, an additional 500,000 new patients will require treatment for OHT as a result of guidelines announced by the National Institute for Health and Clinical Excellence (NICE) in April 2009.
Glaucoma patients require lifelong treatment and so the need for glaucoma care is set to increase year on year as early diagnosis, NICE guidance and longer life expectancy conspire to increase demand.
The NICE guidelines have described how and when to commence treatment for both glaucoma and OHT and offered guidance that patients be re-examined every six to 12 months to evaluate whether their condition is stable. At each assessment, patients should undergo measurement of their visual field (a test of their peripheral vision), their intraocular pressure (which should normally be below 21 mmHg) and an evaluation of their optic disc cup (which gets larger in poorly-controlled glaucoma).
Many HES departments already face severe backlogs of patients who are overdue their regular glaucoma follow-up appointment. In mid-2009 the National Patient Safety Agency (NPSA) alert identified over 100 patients known to have irreversibly lost vision as a result of delays in their review appointment. This figure is likely to be an under-estimate of the true number of patients who have come to harm as a result of overdue glaucoma review.
Many eye-care professionals have hoped that community optometrists will be able provide glaucoma monitoring services where the HES is not able to do-so. The College of Optometry oversees diploma examinations in glaucoma care while recent changes in legislation will allow qualified optometrists to prescribe glaucoma medications.
There is however, considerable doubt about whether there will be sufficient numbers of optometrists with both the qualifications and the inclination to provide the much-needed additional volume of glaucoma care which will be required over the next several years.
Newmedica was established in 2007 in order to provide innovative eye-care services for NHS patients. Since its inception, Newmedica has developed a high-volume mobile electronic glaucoma clinic, specifically to provide support to hard-pressed HES glaucoma departments. One large West Country NHS hospital had long-running problems with overdue glaucoma review appointments with some patients waiting more than a year for the ‘six-month’ review appointment. Since using the mobile clinic, significant delays in glaucoma follow-up appointments have become a thing of the past.
The service has a number of features which facilitate integration with an established hospital glaucoma department.
· Mobile units allow management of up-to 180 established glaucoma patients per week without drawing on already stretched HES resources.
· Newmedica provides a fully staffed clinic run by a glaucoma optometrists assisted by technicians.
· Every patient has a full assessment at every visit (a full examination including pressure measurement, pachymetry, gonioscopy, visual field test and optic disc scan).
· All clinical data is managed via an electronic patient record which enables a consultant ophthalmologist to provide clinical oversight via a web-based virtual clinic.
· The Newmedica EPR facilitates administration functions including defining clinic profiles, booking patients, sending reminders and subsequent re-bookings. All letters (to GPs, optometrists and patients) are automatically generated, removing the need for both secretarial and appointment services.
· Patients are usually in and out of the clinic within an hour.
Jeremy Diamond is a consultant ophthalmologists and medical director of Newmedica