Laser training program enables optometrist-delivered glaucoma treatment in UK
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Key takeaways:
- A standardized laser training program has been needed for nonmedical ophthalmic practitioners providing glaucoma care in the U.K.
- Optometrists demonstrated self-confidence following the program.
An educational training program in the U.K. enabled non-MD ophthalmic practitioners to safely and effectively deliver selective laser trabeculoplasty to patients with glaucoma, according to a study published in Eye.
With more non-MD ophthalmic practitioners involved in the care of patients with glaucoma in the U.K., such a formal and structured training framework has been needed to standardize the quality of laser treatments delivered, according to the researchers.
“In this paper, we wanted to establish a training protocol for optometrist-delivered laser procedures based on medical education principles, importantly informed by previous qualitative research,” Evgenia Konstantakopoulou, MCOptom, PhD, DipTp(IP), MSc, honorary associate professor at UCL Institute of Ophthalmology, told Healio. “We felt it was important to showcase the theory, clinical practice and self-audit principles necessary for procedures that have in the past been exclusively performed by ophthalmologists. For the everyday clinician, this paper is reassurance that, under appropriate training and support, this workforce can use its skills effectively, in a professionally stimulating way and to the benefit of the patients and the NHS.
“Another important point emerging from this work is the need for effective communication between different hospital services, such as ophthalmology and optometry, in order to maintain training standards across all involved professionals,” Konstantakopoulou added. “As indicated in our previous qualitative work, all involved professional groups can benefit from setting training standards, which subsequently benefits patients.”
The training program consisted of three stages: knowledge acquisition and demonstration of procedure, which involved online lectures, case study reviews and hands-on clinical training (stage 1); work-based learning and assessment, which included the completion of supervised laser procedures and competency sign-offs (stage 2); and reflective practice, which included a self-audit after completing 50 SLT procedures and the writing of a reflective statement (stage 3).
To evaluate the performance, safety and outcomes of optometrist-delivered SLT following the training program, Konstantakopoulou and colleagues performed a clinical audit of 240 laser procedures performed by the first six optometrists undergoing the course.
The researchers observed 100% compliance with procedures, which included a risks and benefits discussion, the consent procedure and the correct prescribed post-laser medication.
At 1 hour following treatment, IOP was checked in 99.6% of cases; 96.7% of eyes were given apraclonidine 1% prior to treatment, and 69.6% of the eyes had a gonioscopy performed before SLT delivery.
Out of 240 laser procedures, one eye (0.4%) developed post-laser corneal haze and one eye (0.4%) developed cystoid macular edema, both of which resolved with appropriate treatment without a permanent effect on vision, according to the researchers.
Additionally, nine eyes (3.7%) had an IOP spike (> 30 mm Hg). The researchers noted there were no sight-threatening adverse events.
“Following the training, no additional time and/or training was requested by the optometrists, indicating self-confidence, which has been an issue of uncertainty in apprenticeship format SLT training,” the researchers wrote.
“We now have evidence that this is safe and efficient, and we might need this to be replicated by different research groups to finally consider it part of the country’s everyday practice,” Konstantakopoulou said. “However, papers such as ours following major NHS reports are probably resetting the way we think about nonmedical professionals, and this is a unique opportunity for everyone involved to excel in our clinical skills, collaboration skills and the services we provide to patients.”
Perspective
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Almost 20 years after its introduction, SLT has taken a spot in the limelight as a first-line treatment for primary open-angle glaucoma and ocular hypertension. Based on the LiGHT trial results, use of this safe and effective therapy has steadily increased in recent years, changing its utilization and demand.
To better accommodate the need for SLT, an educational training program for non-MD ophthalmic practitioners was established in the U.K., allowing for expansion in the management of glaucoma with structured and standardized training. Unsurprisingly, the clinical audit data of this study found that optometrists delivered safe SLT treatments.
Based on our aging population and an increased need for eye care services, the role of optometrists as the front-line eye care provider continues to grow. The expansion of optometric scope of practice is critical to address the increased demand for eye care and provide appropriate first-line therapy.
A unified and standardized approach should be the goal for all providers to offer our patients the reasonable access to care that each and every one deserves.
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