Advice on NICE glaucoma guidelines
18 Dec 2009
- The Joint Working Group on NICE Glaucoma Guideline has issued guidance on referral. These can be viewed on the AOP web site.
- The AOP welcomes the guidance from the Joint Working Group on NICE Glaucoma Guideline (two members of which represented the AOP).
- The AOP is particularly happy to note that:
- · The guidance confirms that patients with IOPs measured at greater than 21 mmHg with any tonometer, including NCT, should be referred, except for patients over the age of 65, for whom there is more specific advice in the guidance.
- · The guidance acknowledges tacitly that visual fields are not a requirement for referral. The sentence “Where practitioners have determined that it is clinically necessary to perform a visual field assessment as part of particular eye examination, a copy of the visual field assessment should also be provided“ allows that there may be situations where a practitioner does not think it clinically necessary to perform a visual field assessment.
- The AOP has endorsed this guidance and hopes that all optometrists, all ophthalmologists and all PCTs/LHBs will take heed.
- From AOP 22/4/09 16 page quick reference guide:
- The NICE guidelines provide a framework for the diagnosis and management of Chronic Open Angle Glaucoma (COAG) and Ocular Hypertension (OHT) in England and Wales. The guidelines require that OHT should be formally diagnosed using gonioscopy before continued monitoring; OHT is defined in the guidance as intraocular pressure over 21 mm Hg.
- This, of course, could overwhelm HES departments but our view is that optometrists and optical businesses put themselves at risk unless they comply with the guidelines. It would be helpful for the referral to state that the patient is being referred in accordance with NICE guidelines as having intraocular pressure over 21 mm Hg but without any other signs eg. normal discs and fields.
We will be obtaining further legal advice on this matter and when that is available we will update you. Until that time, and regardless of any suggested solutions made by your local primary care organisation or local ophthalmologists to continue current practice, for legal defence purposes, it is strongly advised to refer all patients with intraocular pressure over 21 mm Hg to an ophthalmologist.
Meantime we are working with the Department of Health and NHS to find a workable solution to the issues created by the guidelines both for the short and longer term. One obvious solution is for more of this work to be carried out in the community by optometrists in optical practices.