Scotland publishes glaucoma care guidelines

The Scottish InterCollegiate Guidance Network has developed a set of guidelines to standardize glaucoma care in the country.

Published last month, the guidelines provide best-practice, evidence-based recommendations on assessment, referrals and discharging glaucoma patients, as detailed on SIGN's website.

Hal Rollason BSc, FCOptom, a member of the SIGN committee, told Primary Care Optometry News that several factors went into the development of the guidelines.

"There was a selection of stakeholder organizations and representatives of those who work in primary and secondary care," he explained. "We first decided on which questions we wanted answers for and then conducted systematic reviews of the evidence, through literature searches and expert opinion."

He said that the committee was focused on standardization of patient care.

"The goals were to produce a standardized examination and monitoring of patients at risk of glaucoma in primary care, produce advice on which patients could be monitored within primary care and which should be referred to secondary care (the hospital eye service), have standardized and equitable tests in primary and secondary care using the same language and descriptors, produce advice on which patients could be safely discharged from secondary care back to their optometrist and free up valuable clinic space within the hospital setting."

Rollason also explained that the guidelines will largely change glaucoma care in Scotland by moving those patients to primary care.

"This has the benefit of being closer to someone’s home, less travel time and cost, easier access, longer opening hours and familiarity with the same optometrist providing that care," he said. "This fits in with shifting the balance of care and providing the right care in the right setting at the right time. I expect that in many cases the glaucoma review could take place at the same time as the routine eye examination provided by General Ophthalmic Services (GOS)."

There has been a significant change in the practice of optometry in Scotland over the past 10 years, Rollason noted, as the GOS 2006 Regulations SSI 135 provided "greater responsibility for patients they saw in primary care."

This included glaucoma patients, though there was no actual guidance regarding monitoring, referring and discharging patients.

Rollason concluded: "This guidance, therefore, standardizes what optometrists should do in primary care and allows the Hospital Eye Service to discharge patients to primary care with detailed information and re-referral criteria.” – by Chelsea Frajerman