NICE accredited guidance on commissioning glaucoma services
6 June 2016
The Royal College of Ophthalmologists and Clinical Council for Eye Health Commissioning publish NICE accredited guidance on commissioning glaucoma services
Clinical Commissioners are asked to review existing services against the recommendations contained in the new guidance to ensure the most cost effective and resource efficient services are available to meet demand.
The NEW Commissioning Guide for Glaucoma is a resource to assist commissioners, clinicians and managers to deliver successful and efficient hospital eye services (HES) across England and the rest of the UK. The healthcare recommendations are made on high quality and evidence-based outcomes.
Glaucoma is a common sight threatening disease and if not diagnosed, monitored and treated correctly, can result in severe loss of vision or blindness that is not recoverable. Approximately 10% of UK blindness registrations are related to glaucoma. Successful management of glaucoma requires lifelong monitoring and treatment to prevent or minimise further vision loss; on average a person diagnosed with glaucoma will have one initial visit and 40 follow up visits.
Around half a million people are currently affected by chronic open angle glaucoma (COAG), the most common type of glaucoma and there are over a million glaucoma-related outpatient visits in HES.
To lessen the burden on HES, NICE compliant care setting options for people with glaucoma or at risk of glaucoma include additional provision of commissioned services in the community under appropriately governanced contracting. Fifty per cent of glaucoma in the community remains undiagnosed; previously undetected cases are largely identified at routine sight tests by community optometrists.
Successful management of glaucoma requires lifelong monitoring and treatment to prevent or minimise further vision loss. On average, a person diagnosed with glaucoma will have one initial visit and 40 follow up visits. It is vital that these follow up appointments are managed effectively and recommendations in the guidance calls for commissioners to ensure capacity to enable ‘access to timely follow-up appointments and specialist investigations’ as set out in NICE Quality Standard 8.
The commonest type of glaucoma in the UK is chronic open angle glaucoma (COAG), affecting around 2% of people older than 40 years and rising to almost 10% in people older than 75 years in white Europeans. Around half a million people are currently affected by COAG in England and there are over a million glaucoma-related outpatient visits in the hospital eye service (HES) annually. The number of individuals affected by COAG is expected to rise due to changes in population demographics.
The prevalence of COAG is higher in people of black African or black Caribbean descent and in people who have a family history of the condition. These people, as well as people living in deprived areas with poor access to services, are at highest risk of becoming blind due to glaucoma.
There is evidence that the most deprived geographical areas are least served by optometry practices and people in these areas may therefore be at an increased risk of a delayed diagnosis of glaucoma. Similarly, there may be missed cases of glaucoma in ‘hard to reach’ groups, including vulnerable individuals, homeless people, and people with special needs, where access to routine optometric services and opportunistic case finding may be limited or unavailable.
About the Clinical Council for Eye Health Commissioning
The Clinical Council for Eye Health Commissioning (CCEHC) coordinates leading organisations from across eye health to offer united, evidence-based clinical advice and guidance to those commissioning and delivering eye health services in England on issues where national leadership is needed.
Its member organisations are:
- The Royal College of Ophthalmologists
- The College of Optometrists
- Association of Directors of Adult Social Services
- Association of British Dispensing Opticians
- British and Irish Orthoptic Society
- Faculty of Public Health
- International Glaucoma Association
- Local Optical Committee Support Unit
- Macular Society
- Optical Confederation
- Royal College of Nursing (Ophthalmic nursing forum)
- Royal National Institute of Blind People
- VISION 2020 UK