1
|
Konstantakopoulou E, Varia J, Parmar J, Nathwani N, Hau S, Low WS, Edwards LA, Laber E, Bhalla M, Gazzard G, Jayaram H. Optometrist-delivered selective laser trabeculoplasty in the HES - a training protocol and early service evaluation. Eye (Lond) 2024:10.1038/s41433-024-03086-1. [PMID: 38702512 DOI: 10.1038/s41433-024-03086-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 03/05/2024] [Accepted: 04/11/2024] [Indexed: 05/06/2024] Open
Abstract
Over the last decade, the delivery of glaucoma care in the UK has changed dramatically, with more non-medical ophthalmic practitioners involved in the care of glaucoma patients. Optometrists and other non-medical professionals are now involved in the delivery of laser treatments in the Hospital Eye Service (HES), but there is currently no standardised national training framework for non-medical clinicians. Moorfields Eye Hospital and UCL's Institute of Ophthalmology have developed and delivered an education and training programme for the delivery of lasers, including Selective Laser Trabeculoplasty (SLT) by non-medical ophthalmic practitioners. The training programme is based on medical education principles, is informed by previous qualitative research into the role of ophthalmic practitioners in the delivery of laser treatments and is expected to have multidisciplinary benefits for ophthalmic healthcare. Clinical audit data indicate that optometrists can deliver safe SLT treatments, adhering to local protocols.
Collapse
Affiliation(s)
- Evgenia Konstantakopoulou
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and the UCL Institute of Ophthalmology, London, UK.
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK.
- Optometry Education, Moorfields Eye Hospital NHS Foundation Trust, London, UK.
- Division of Optics and Optometry, University of West Attica, Athens, Greece.
| | - Jay Varia
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and the UCL Institute of Ophthalmology, London, UK
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Optometry Education, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Janisha Parmar
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and the UCL Institute of Ophthalmology, London, UK
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Optometry Education, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Neil Nathwani
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and the UCL Institute of Ophthalmology, London, UK
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Optometry Education, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Scott Hau
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and the UCL Institute of Ophthalmology, London, UK
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Optometry Education, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Wing Shing Low
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Laura A Edwards
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Emma Laber
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Minak Bhalla
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Gus Gazzard
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and the UCL Institute of Ophthalmology, London, UK
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Hari Jayaram
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and the UCL Institute of Ophthalmology, London, UK
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| |
Collapse
|
2
|
Sharma O, Jones L, Sii F, Whittaker J, Dulku S, Lee G, Kirwan J, Sharma T, Shah P. Mapping vision loss of patients in a glaucoma backlog following the COVID-19 pandemic: a real-world analysis using the Glauc-Strat-Fast risk stratification tool. Eye (Lond) 2024; 38:1005-1011. [PMID: 37980397 DOI: 10.1038/s41433-023-02821-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/20/2023] [Accepted: 10/30/2023] [Indexed: 11/20/2023] Open
Abstract
INTRODUCTION Glauc-Strat-Fast is a clinical tool recommended by The Royal College of Ophthalmologists to classify glaucoma patients into strata of risk for significant future sight loss and an estimate of resource requirement. The aim of this study was to map the movement of glaucoma patients across stratification boundaries on Glauc-Strat-Fast during the COVID-19 pandemic. SUBJECTS AND METHODS Glauc-Strat-Fast was applied to a consecutive sample of 100 primary open angle glaucoma patients in a backlog at Worcestershire Acute Hospitals NHS Trust. Stratification outcomes were compared between clinic visits prior to the COVID-19 pandemic versus the follow-up visit. Patients were stratified twice separately based on their worse eye (i.e., most affected) and better eye (i.e., least affected) according to Glauc-Strat-Fast. RESULTS Amount of slippage (difference between target follow-up and actual follow-up) ranged from 2 to 32 months. There was a statistically significant average reduction in visual field mean deviation for better and worse eyes between visits (p = <0.001). At follow-up, no worse eyes were classified as being low risk (green), while 96 were classified as high risk (red). For better eyes, elevation of risk into the highest strata of Glauc-Strat-Fast observed a three-fold increase in patients (19 versus 56) between visits. DISCUSSION This retrospective real-world analysis highlights patients' movement into the highest strata on the Glauc-Strat-Fast tool and demonstrates a significant deterioration in visual outcomes during a period of extensive appointment slippage. The findings demonstrate the utility of Glauc-Strat-Fast as a tool for improved patient management.
Collapse
Affiliation(s)
- Ojasvi Sharma
- Medical School, University of Nottingham, Nottingham, UK
| | - Lee Jones
- University College London, Institute of Ophthalmology, London, UK
- BRAVO VICTOR, Department of Research, London, UK
- Birmingham Institute for Glaucoma Research, Institute of Translational Medicine, Birmingham, UK
| | - Freda Sii
- Birmingham Institute for Glaucoma Research, Institute of Translational Medicine, Birmingham, UK
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jonathan Whittaker
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Simon Dulku
- Birmingham Institute for Glaucoma Research, Institute of Translational Medicine, Birmingham, UK
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Graham Lee
- Department of Ophthalmology, Mater Hospital, Brisbane, QLD, Australia
- University of Queensland, Brisbane, QLD, Australia
| | - James Kirwan
- Department of Ophthalmology, Queen Alexandra Hospital, Portsmouth, UK
| | - Tarun Sharma
- Worcestershire Acute Hospitals NHS Trust, Ophthalmology Department, Worcester, UK.
| | - Peter Shah
- University College London, Institute of Ophthalmology, London, UK
- Birmingham Institute for Glaucoma Research, Institute of Translational Medicine, Birmingham, UK
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- University of Wolverhampton, Centre for Health and Social Care Improvement, Wolverhampton, UK
| |
Collapse
|
3
|
Gunn PJG, Read S, Dickinson C, Fenerty CH, Harper RA. Providing capacity in glaucoma care using trained and accredited optometrists: A qualitative evaluation. Eye (Lond) 2024; 38:994-1004. [PMID: 38017099 DOI: 10.1038/s41433-023-02820-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 10/02/2023] [Accepted: 10/30/2023] [Indexed: 11/30/2023] Open
Abstract
INTRODUCTION The role of optometrists in glaucoma within primary and secondary care has been well described. Whilst many studies examined safety and clinical effectiveness, there is a paucity of qualitative research evaluating enablers and barriers for optometrists delivering glaucoma care. The aims of this study are to investigate qualitatively, and from a multi-stakeholder perspective whether optometric glaucoma care is accepted as an effective alternative to traditional models and what contextual factors impact upon their success. METHODS Patients were recruited from clinics at Manchester Royal Eye Hospital and nationally via a Glaucoma UK registrant database. Optometrists, ophthalmologists, and other stakeholders involved in glaucoma services were recruited via direct contact and through an optometry educational event. Interviews and focus groups were recorded and transcribed anonymously, then analysed using the framework method and NVivo 12. RESULTS Interviews and focus groups were conducted with 38 participants including 14 optometrists and 6 ophthalmologists (from all 4 UK nations), and 15 patients and 3 commissioners/other stakeholders. Themes emerging related to: enablers and drivers; challenges and barriers; training; laser; professional practice; the role of other health professionals; commissioning; COVID-19; and patient experience. CONCLUSION Success in developing glaucoma services with optometrists and other health professionals is reliant on multi-stakeholder input, investment in technology and training, inter-professional respect and appropriate time and funding to set up and deliver services. The multi-stakeholder perspective affirms there is notable support for developing glaucoma services delivered by optometrists in primary and secondary care, with caveats around training, appropriate case selection and clinical responsibility.
Collapse
Affiliation(s)
- Patrick J G Gunn
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Simon Read
- School of Health and Social Care, Swansea University, Swansea, SA2 8PP, UK
| | - Christine Dickinson
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Cecilia H Fenerty
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Robert A Harper
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Centre for Applied Vision Research, City, University of London, London, UK
| |
Collapse
|
4
|
Hansraj R, Dlamini N, Khan S, Mtolo PC, Ntuli NG, Prithipal C, Salajee H, Xulu-Kasaba ZNQ. Ocular therapeutics and the profession of optometry in South Africa. Afr J Prim Health Care Fam Med 2024; 16:e1-e10. [PMID: 38299541 PMCID: PMC10839208 DOI: 10.4102/phcfm.v16i1.4140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/07/2023] [Accepted: 10/19/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND The role of an optometrist as defined by the World Council of Optometry includes the management of ocular diseases. In 2015, the scope of optometry in South Africa was expanded to include ocular therapeutic drugs. To date approximately 27 optometrists have obtained full certification to exercise ocular therapeutic privileges. AIM This study aimed to determine the interest, readiness, as well as challenges, of optometrists for the inclusion of ocular therapeutics into daily practice. SETTING The study was set in South Africa. METHODS A descriptive, cross-sectional study design was employed. Convenience sampling was used to recruit 420 participants from a study population of optometrists registered with the Health Professions Council of South Africa, with data collected using an online questionnaire hosted on social media platforms and distributed by professional organisations. Data were analysed using the Statistical Package for Social Science version 27. RESULTS The majority of respondents (73.3%) reported keenness for ocular therapeutics certification. While 75.7% of respondents had obtained diagnostics certification, only 9.5% were registered with the Health Professions Council of South Africa (HPCSA) with ocular therapeutics certification. Most (92.1%) respondents reported the required minimum of 600 h of clinical training as a major challenge to obtaining ocular therapeutics certification. Almost all (96.9%) of the respondents agreed that ocular therapeutics certification will improve provision of optimal eyecare. CONCLUSION South African optometrists support and are personally interested in ocular therapeutics certification. However, while there is a preponderance of diagnostically qualified optometrists, very few are certified for ocular therapeutics with completion of the required clinical training for certification perceived as the greatest challenge.Contribution: This findings in this study highlight that, current requirements to support ocular therapeutics certification of South African optometrists should be reviewed to ensure an enabling environment for the completion of the clinical training.
Collapse
Affiliation(s)
- Rekha Hansraj
- Department of Optometry, College of Health Sciences, University of KwaZulu-Natal, Durban.
| | | | | | | | | | | | | | | |
Collapse
|
5
|
Selective laser trabeculoplasty (SLT) performed by optometrists-enablers and barriers to a shift in service delivery. Eye (Lond) 2021; 36:2006-2012. [PMID: 34389819 PMCID: PMC8362647 DOI: 10.1038/s41433-021-01746-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/22/2021] [Accepted: 08/03/2021] [Indexed: 11/08/2022] Open
Abstract
Background/objectives To explore the acceptability, training requirements, enablers and barriers of optometrist-delivered SLT. Subjects/methods Optometrists, fellowship and consultant grade ophthalmologists, hospital managers and patients were interviewed using pre-defined topic guides. Interviews were audio-recorded, transcribed, and subjected to thematic analysis. Overarching themes were defined by the study aims and the topic guides; subthemes were derived from the interview data. Results Sixty-six participants (three managers, eight glaucoma specialist consultant ophthalmologists, seven clinical glaucoma fellows, 12 optometrists (two of them performing SLT), two ophthalmic nurses and 34 patients) participated in the study. Overarching themes (and subthemes) were: necessity of non-medical SLT delivery, clinical practice and training, advantages, disadvantages, concerns, challenges, community delivery of SLT, patient values and other healthcare professionals that could also deliver SLT. Conclusions Certain clinical pre-requisites, such as gonioscopy and independent prescribing rights, were perceived as necessary for undertaking SLT training. An optometrist-delivered SLT service was expected to benefit the NHS, but there was an identified need of a standardised training scheme and robust governance. Patients were accepting of an optometrist-delivered SLT service in the hospital eye service.
Collapse
|