College-funded research finds glaucoma referral scheme to be successful in filtering patients effectively

  • 20 Nov 2018

Research resulting from the College's Enhanced Scheme Evaluation Project demonstrates that a glaucoma filtering scheme in Manchester has been highly successful in filtering patients.

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Research resulting from the College of Optometrists' Enhanced Scheme Evaluation Project (ESEP) demonstrates that a glaucoma filtering scheme in Manchester has been highly successful in filtering patients, with low false positive (FP) and false negative (FN) rates. The results should provide reassurance to commissioners considering implementing glaucoma pathways. 

The research, published in the British Journal of Ophthalmology, evaluated the clinical effectiveness of a Glaucoma Enhanced Referral Service (GERS) in Greater Manchester. It is the seventh ESEP paper to be published in peer-reviewed journals since 2014. 

The latest ESEP study found that:

  • The Manchester GERS is highly successful in reducing the FP rate from community referrals for suspect glaucoma
  • The FN evaluation showed that the scheme is clinically effective and very safe
  • There was a low referral rate to the HES, with 53.6 per cent of patients being discharged following GERS community assessment, potentially providing a financial saving to the NHS
  • Of the patients not referred to the HES through this scheme, only one patient (0.8 per cent) met the GERS criteria but was not referred. There were no cases of missed glaucoma or non-glaucomatous pathology identified within the study sample 
  • Previous studies have shown that, without ‘filtering’ the FP rate for suspect glaucoma referrals is high (approximately equal to 40 per cent) 
  • A validation study found that the GERS glaucoma specialist optometrists’ decision-making demonstrated non-inferiority when compared to consultant-to-consultant agreement. There was agreement between consultant on management decisions in 23 of 30 non-referred cases versus 25 of 30 and 24 of 30 cases when the specialist optometrist, and each individual consultant, were in agreement. 

Mike Bowen, Director of Research for the College of Optometrists said: “This research, and the broader Enhanced Scheme Evaluation Project, has provided evidence, where very little existed before, that optometrists working in community/enhanced schemes is both safe and cost-effective. We are confident that these latest findings will encourage commissioners to duplicate this type of scheme, with the reassurance that outcomes for patients, far from being compromised, will actually be enhanced.” 

Patrick Gunn, Principal Optometrist (Training and Education), Manchester Royal Eye Hospital and First Author said: “The ESEP project shows where there is a good partnership between community optometry and the hospital eye service, with appropriate training and accreditation, schemes such as the Manchester GERS are highly clinically effective and safe.” 

The College’s ESEP continues. The researchers will next undertake a retrospective health economics analysis of GERS. More information about ESEP can be found on the College website. The College funds, delivers and disseminates research to help develop the evidence base for optometry and vision science. More information about helping to fund College research is available on the College website. 


Notes to Editors

  1. The Enhanced Scheme Evaluation Project (ESEP) was funded by the College of Optometrists in 2012 to evaluate different community-based eye care service models. The project is led by researchers from City, University of London and the Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust. ESEP aims to assess the effectiveness of enhanced eye care services schemes (ESS) including a Minor Eye Conditions Scheme (MECS) in South East London and the Glaucoma Enhanced Referral Service (GERS) in Greater Manchester. 
  2. Under the Manchester GERS pathway, all Manchester patients identified by their optometrist as a glaucoma suspect requiring referral should be directed to GERS for referral filtering, unless emergency referral is required. Following GERS assessment, patients are directly referred to the HES glaucoma service, discharged to community optometry care or referred to the HES via GOS 18 referral form where non-glaucomatous pathology is identified. The aim of this service is to provide a safe and efficient pathway for patients to be reviewed promptly after referral for suspect glaucoma, closer to home, by accredited optometrist, while reducing the FP referral rate to the HES.
  3. The College is the professional body for optometry. It qualifies the profession and delivers the guidance and training to ensure optometrists provide the best possible care. We promote excellence through the College’s affixes, by building the evidence base for optometry, and raising awareness of the profession with the public, commissioners, and health care professionals.


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