Optometry led delivery of glaucoma treatment
Professor Gus Gazzard | GR001067
Moorfields led research has demonstrated that changes to the treatment pathway for some glaucoma patients improves outcomes. They showed that a combination of traditional medicine and laser treatment was more effective than traditional medicines alone.
We are now funding a follow on study looking at the barriers and opportunities of an optometry led service delivering laser treatment to glaucoma patients.
Glaucoma is when damage to the optic nerve causes sight loss, usually caused by the pressure inside the eye rising too high. The optic nerve transmits signals from the eye to the brain, so damage to it can lead to sight loss. It is not possible to restore any vision that is lost but treatment can prevent further progression.
Percentage of people over 40 who have glaucoma
The number of people living with glaucoma in the UK
Current treatments for glaucoma aim to reduce pressure that has built up in the eye, either with surgery, laser treatment or eye drops.
Moorfields Eye Charity is supporting the LiGHT Trial. This large multi-centre trial examined the quality of life of patients of two sets of glaucoma patients who received different regimes of existing treatments. These groups were patients who either start treatment with traditional medicines (like eye drops) or who are treated with both a form of therapy called selective laser trabeculoplasty (SLT) as well as traditional medicines.
From results published so far, the trial found that commencing treatment with SLT and traditional medicines was more effective than commencing treatment with traditional medicines alone. As well as this, it could allow the NHS to save up to £250 million per year if the treatment is effective for new and previously diagnosed patients.
The National Institute for Health and Clinical Excellence are amending guidelines to support the use of SLT as a first line treatment.
However, the procedure currently needs to be undertaken by a medically trained ophthalmologist. This has the impact of limiting the speed and number of patients who can access this type of treatment.
Finding a solution
Optometrist Dr Evgenia Konstantakopoulou, together with Professor Gus Gazzard and Dr Lee Jones have been awarded a service innovation grant. With this, they will undertake a scoping review to understand the enablers and barriers of introducing an optometrist delivered SLT service. The study will review and analyse similar services delivered in the UK and will discuss the possibility of an optometrist delivered SLT service with stakeholders.
The role of ophthalmologists and optometrists
Ophthalmologists are medically trained professionals who deal with the diagnosis, treatment and prevention of diseases of the eye. They can act as both physicians and surgeons. The training for this role involves an undergraduate medical degree, two foundation years and specialist training which lasts up to seven years.
Optometrists examine the eyes to check the quality of vision and for any defects caused by injury or disease. They can prescribe glasses or contact lenses and refer patients for further medical treatment, if required. Optometrists undertake an undergraduate degree in optometry and then complete a placement with a registered optometrist. They are required to pass three assessment stages set out by the College of Optometrists.
Patients’ views will be explored to ensure that there would be added value in offering this type of service. In addition, the opinions of ophthalmologists and optometrists about the training requirements will be explored.
A protocol - a description of the methodology - for the study has already arisen from this funded project and is published in BMJ Open Ophthalmology.
The study will shed light on the possibility of optometrists delivering SLT and whether further research is needed including about efficacy, safety and cost-effectiveness.
An optometrist delivered service has the potential to allow more patients to access the treatment. It could free up ophthalmologists to focus on more clinically complicated cases and offer more professional development to optometrists.
Professor Gus Gazzard
Glaucoma, service improvement, patient experience