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Optimizing Community Monitoring of Intraocular Pressure in Light of New NICE Guidance

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kirti
55 diapositives · 736 Views · Aug 20, 2014

This document discusses the implications of the new NICE guidance on the diagnosis and management of ocular hypertension (OHT) for patients with intraocular pressure (IOP) greater than 21 mmHg but no other signs of glaucoma. It highlights concerns from the optical community about the potential for overwhelming hospital eye departments with unnecessary referrals. The exchange emphasizes maintaining effective community monitoring strategies, improving training, and utilizing technology to enhance the service while ensuring patient safety and sight preservation.

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  1. IOP Refinement Trevor Warburton LOCSU Associate

  2. Background • April 2009 • New NICE Guidance

  3. Optical comment to NICE Currently a very large number of patients with intraocular pressure greater than 21 mm Hg, but with no other signs of glaucoma, are being successfully monitored by optometrists in the community with no evidence of visual loss occurring as a result…

  4. Optical comment to NICE One of the recommendations of the draft guidance is that OHT should be formally diagnosed for intraocular pressure greater than 21 mm Hg... ...many thousands of patients will be referred for a diagnosis over a very short period of time, overwhelming hospital eye departments with many false positive patients.

  5. NICE Response Thank you for your comment. After careful consideration we came to the conclusion that we do not agree... All of this exchange is on the NICE website!

  6. Optical Advice • FAQs • We can repeat • Not funded in GOS

  7. Tonometry • NCT – gets a lot of criticism • Very common, quick and easy • Can be performed by support staff • Hence almost universal use in GOS despite no change in funding • It has saved a lot of sight

  8. Tonometry • The problem • NCT is very sensitive • But not as specific as GAT • Hence an increase in referrals

  9. More Guidance • 4 readings • With NCT • 2 special groups…

  10. More Guidance • No treatment

  11. More Guidance • May consider not referring • Assuming normal discs, fields and angles open by Van Herick • Age 80 and over with IOP <26 • Age 65 and over with IOP <25

  12. LOCSU CET • No accreditation should be necessary for repeating IOPs • It’s a core competency • Refresher in GAT should be offered • There is CET available • It is likely to be accreditation if there is an OHT monitoring scheme in the future • Includes video on GAT

  13. LOCSU CET • From LOCSU • Free • VF • Discs • IOP • 8 CET points

  14. LOCSU CET

  15. LOCSU CET • LOCs can obtain the access codes (and by the way the new cataract CET is here now)

  16. LOCSU Level 1a IOP repeats

  17. Introducing schemes • Keep it simple • Remember the goal • Reducing referrals, not perfection • Use Perkins as well as Goldmann • Offer refreshers, not accreditation • Maximum participation

  18. Pilot IT system • Entirely online • Web-based • No software to be installed

  19. Pilot IT system • Why online only? • Ease of data collection • Figures for • Individual activity • Payment • Overall effectiveness • Of 1 repeat vs 2

  20. Repeat IOP Scheme Started 1st Feb Figures for 1st 6 months

  21. Repeat IOP Scheme • 311 patients so far • 77% deflected • 23% referred

  22. Participation • 35 fixed practices in the area • 26 are participating (74%) • 1 further large practice soon

  23. IT • Development funded by LOCSU • Stockport was the pilot • Now running in the adjacent T&G • Seamless across 2 areas • Available anywhere that wants it

  24. Protocol • Protocol • Describes service • What to do • Easily updated • Downloadable • SLA • Simple • Electronic

  25. Named individual 2 skips only

  26. Main page • List of patients & status • Manage tonometer defaults • Manage practitioners

  27. Set Defaults • Sight test tonometer • Repeat tonometer

  28. Manage practitioner • No accreditation • Contractors are responsible for performers • Can manage their own practitioners