College calls for glaucoma care shift by fully unlocking safe and effective primary care capacity

Ophthalmology outpatient waiting lists are already one of the largest contributors to the UK health services’ backlogs, with glaucoma accounting for around 20-25% of hospital eye services outpatient activity.  

A new evidence review of optometry-led glaucoma primary eye care services by The College of Optometrists highlights how referral filtering services and shared care-based pathways for low-risk and stable glaucoma patients are a safe and effective solution to reduce hospital glaucoma waiting lists.  

Universal commissioning of targeted enhanced glaucoma services in primary care across the UK would help prevent avoidable sight loss and create sustainable models of shared patient care that meet the needs of an ageing population.  

Glaucoma is typically asymptomatic in its early stages and most patients’ cases are initially detected by optometrists at routine eye tests and then referred into hospital eye services. Published evidence shows that 40% to 75% of new glaucoma patient referrals to hospitals could be prevented with effective use of glaucoma referral filtering services (GRFS), such as glaucoma repeat measures services, in the community.

These services are delivered by optometrists in primary care to reduce the relatively high number of false-positive referrals reaching hospital services, while maintaining clinical effectiveness and ensuring patient safety. 

GRFS have freed up thousands of hospital appointments. Patient satisfaction is consistently high, with people reporting shorter waiting times, less travel and better communication.

While GRFS are currently commissioned in Scotland, Wales and Northern Ireland, the availability of glaucoma referral filtering services is inconsistent across England. This leads to significant variation in glaucoma care across England in terms of referral quality, waiting times and outcomes.

The analysis also concludes that community glaucoma shared care pathways, which allow trained optometrists to assess, monitor and manage low-risk patients in primary care rather than the hospital, should be universally adopted across the UK. Currently these services are being fully rolled out across Scotland and Wales, and a service for patients with ocular hypertension (a risk factor for glaucoma) is available in Northern Ireland. 

Crucially, this approach also improves safety by ensuring that hospital specialists can focus their attention on patients with complex cases and those who are at highest risk of sight loss.