Patient case studies highlight importance of primary and secondary care relationships

Collaboration between community optometrists and ophthalmologists is essential for glaucoma care was the message delivered by Newmedica medical director, Nigel Kirkpatrick, during a Main stage education session delivered at 100% Optical last weekend (ExCeL, 1–3 March).

Kirkpatrick highlighted that patient access to services was “patchy” across the 43 integrated care boards (ICBs) in England which commission local health services.

He told delegates: “There are estimated to be thousands of backlogged patients per ICB. Widespread variation across the NHS is the norm.”

“Treatment prevents visual field loss,” he added.

During his presentation, Kirkpatrick utilised the case study of a 49-year-old woman to highlight how collaboration between community optometry and ophthalmology ensures timely access to care and treatment.

When referred from community optometry, the patient had an intraocular pressure (IOP) reading of 27 mmHg in the right eye and 26 mmHg in the left eye. Eight weeks later, the patient was seen by a glaucoma accredited and independent prescribing (IP) optometrist.

Kirkpatrick shared with delegates that the optometrist noted no evidence of glaucoma, but felt a risk of visual impairment was possible due to the patient’s age. Treatment was discussed and selective laser trabeculoplasty (SLT) offered. This management was reviewed virtually by a consultant glaucoma sub-specialist and a plan agreed.

The medical director detailed that the patient was seen four weeks later and a bilateral 360-degree SLT procedure performed.

He concluded that eight weeks later, the patient was seen once more by the glaucoma and IP optometrist with no concerns – IOP had reduced after SLT – and a recommendation for follow-up six months later, with the plan agreed by the consultant following a virtual review.

Kirkpatrick noted that evidence of referral refinement to reduce false positives was key.

At the first appointment, optometrists should “plan for accurate diagnosis at first assessment – risk categorisation to determine next step” and the “need to provide accurate repeatable testing at every visit,” he explained.

He added that for follow-ups it was important for practitioners to use the Royal College of Ophthalmologists and the College of Optometrists’ guidance on glaucoma management.

During the lecture, Kirkpatrick also discussed patient case studies with delegates that focused on cataract surgery and age-related macular degeneration, with the aim of demonstrating the role of community optometry and ophthalmology integration to reduce preventable sight loss.

Kirkpatrick highlighted: “Optometrists are part of the solution and play a crucial role in early detection and follow-up. Patient empowerment and patient-centred care is the way forward. Patient choice remains key.”