Glaucoma services in Northern Ireland and other parts of the UK came under significant pressure as the number of ocular hypertensive referrals to the service increased in recent years (Ratnarajan et al. 2013; Shah and Murdoch 2011). This was a result of the implementation of National Institute for Health and Care Excellence (NICE) Clinical Guideline 85 in 2009, coupled with a recommendation from the Association of Optometrists that all patients presenting with repeatable intraocular pressures (IOPs) of more than 21mmHg should be referred to an ophthalmologist regardless of the type of tonometer used to make the measurement (Association of Optometrists 2010).

Northern Ireland’s Health and Social Care Board engaged with the Belfast Local Commissioning Group and other key stakeholders to commission a redesign of glaucoma services with the aim of refining glaucoma referrals and reducing the false-positive referrals which were flooding the hospital eye service (HES).