Optometrists are the linchpin in UK eye care. We are the first port of call for patients with ocular problems, we are the most common source of referral to secondary eye care, and we are becoming increasingly involved in diagnosing and treating patients alongside our ophthalmology colleagues. This gives us a privileged position, where we can provide primary care to those who really need it, ensure those who need more specialist care get referred appropriately, and actively participate in their treatment when they get to hospital.
Unfortunately, not all of those who need care receive it. Health inequality exists even in the UK, with a national health system that, on paper, looks as if it should provide equal care to all. This is something I have seen first-hand when we set up the Vision Care for Homeless People clinic in Exeter, with many adults attending for their first-ever eye examination. People in deprived socioeconomic groups simply do not access the healthcare they need, even when they are entitled to NHS funding. This results in worse outcomes and higher morbidity in these groups. We shed light on why this may be the case and what can be done to combat the problem in our cover feature. Research has confirmed anecdotal evidence that public perception of the purpose of an eye examination is a key factor, and although GOS eye examination funding is also a factor, making more people eligible for funding does not reduce inequality. The solution is unclear, but placing more emphasis on the clinical aspects of the eye examination, in advertising and funding, might encourage patients to attend. It may also persuade optometrists to provide the clinical services in the areas that really need them, facilitating earlier diagnosis and referral.
We touched on how to write effective referrals in the Winter 2019 issue of Acuity, but in this issue an insightful interview with Dr David Parkins highlights the importance of ongoing training in ensuring appropriate, high-quality referrals. With recent changes in the CET structure, optometrists have become much better at talking about difficult cases through peer review. Sharing thoughts and experience is particularly important for newly qualified optometrists. However, improved training and mentorship are not the only factors affecting referral quality; repeat tests and referral refinement are also helpful.
Referral refinement schemes are a good example of how the role of the optometrist is becoming increasingly clinical. Now, some optometrists in secondary care are trained to provide treatment, not just in the form of eye drops via the independent prescribing qualification, but also by delivering intravitreal injections or laser treatment. It’s just as well, as the recently published LiGHT study suggests that selective laser trabeculoplasty could become an effective first-line treatment for many patients with glaucoma.
The number of patients with glaucoma is growing steadily, and Gus Gazzard, Director of the Glaucoma Service at Moorfields, believes optometrists will be required to meet the growing demand for this treatment.
It’s wonderful to see these new opportunities becoming available. The scope of practice we can enjoy as optometrists is something I love about the profession. I hope there’s something for everyone in this edition of Acuity too.
