GLOC Pack Version1 Feb 2007 - glosloc.co.uk

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Resource Pack

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GLOC Resource Pack-Version1-February 2007

www.glosloc.co.uk

Welcome to Gloucestershire

Dear Practice Manager Please find enclosed a copy of the new Gloucestershire LOC Resource Pack detailing the optometric and ophthalmology services available in Gloucestershire. This pack is primarily designed to inform all optometrists moving into the Gloucestershire area about the locally negotiated protocols, support services and help available within the county. It is designed to provide important and up-to-date information which we felt would be useful for all existing practices in the county. It comes in a loose leaf folder which will enable us to update the pack as and when the need arises simply by replacing the relevant page.

If you have any questions or require any further information please feel free to contact any one of the committee members and we would be very happy to help where we can.

The LOC website is used as the main means of providing relevant information for all optometrists in the county. It contains up-to-date information on the activities of the LOC, information about committee members and contact details, and both essential and general information on practising within Gloucestershire. All of the forms contained within the pack are on the website in a format which enables them to be downloaded as required.

We hope you will find this pack interesting and informative. We suggest it is made available as a resource to all the optometrists working in your practice by placing it in an accessible location. If there are any aspects of optometric practice that you feel could be included in future editions or you would like any further information, please do not hesitate to contact one of the committee. Yours sincerely David Adams Chairman Gloucestershire Local Optometric Committee Email: [email protected] Tel: 01594 823690


GLOC Resource Pack-Version1-February 2007 2

PACK CONTENTS

Page

Chairman’s Letter Committee Members

3

GOS Matters

4

Ophthalmology in Gloucestershire

5

Cataract

• Guidelines for Cataract Direct Referral 8 • Guidelines for referring patients with age-related macula disease who

are likely to benefit from cataract surgery 10

• Copy of Cataract Referral Form 12 • Copy of Cataract Claim Form 14 • Cataract Choice 15

Management of wet age-related macular disease (AMD)

16

• Copy of Wet AMD referral form 17 Low Vision

18

The Gloucestershire Glaucoma Project 20

Hospital Optometry Services

21

Diabetic Screening Service

21

Gloucestershire Primary Care Trust 22

The Three Counties Optometry Society 23


COMMITTEE MEMBERS

David Adams Chairman [email protected]

01594 823690

Jeff Poole Secretary [email protected]

01453 885534

Steve Guilford Treasurer [email protected]

Michael Bailey [email protected]

Lisa Collins [email protected]

Laura Dalton [email protected]

Keith Holland [email protected]

Dermot Keogh [email protected]

Kevin Tait [email protected]

John Weygang [email protected]



GOS MATTERS

To apply to join either the Supplementary Ophthalmic List or Contractor Ophthalmic List in Gloucestershire please download the application form from the LOC website, complete and send to the FHS Contacts Team at the address below. Applicants will be required to provide ORIGINAL qualification certificates, 2 recent clinical references, proof of identity and an ophthalmic indemnity certificate. A Criminal Record Bureau (CRB) check will also have to be carried out if the applicant has not obtained an enhanced CRB disclosure within the last six months.

Please contact the FHS Contracts Manager on 01452 300222, if you require a CRB application form to be sent to you, as this is not an electronic document, or any assistance with the application process.

Contracts Team Gloucestershire FHS Shared Services Victoria Warehouse The Docks Gloucester GL1 2EL Tel: 01452 300222

For other queries regarding GOS sight tests and to obtain copies of all other relevant NHS forms contact:

Ms Carol Doelman NHS Finance & Procurement Shared Services Victoria Warehouse The Docks Gloucester GL1 2EL

or telephone (01452) 300222

As reminder, please find listed here the GOS-NHS CLAIM FORMS that you may need – GOS1 Application for an NHS funded sight test GOS2 Patient’s optical prescription or statement

GOS3 NHS optical voucher and patient’s statement

GOS4 NHS optical repair/replacement voucher application form

GOS5 Help with the cost of a private sight test

GOS6 Application for a mobile NHS funded sight test

HC1 Claim for help with health costs

HC11 Help with health cost


OPHTHALMOLOGY IN GLOUCESTERSHIRE

The main provider of NHS ophthalmology services is Gloucestershire Hospitals NHS Foundation Trust. The ophthalmology department consists of eleven Consultant Ophthalmologists, a growing number of Associate Specialists, Fellows, Staff grades and Senior House Officers and a large associated support team of nurses, optometrists and orthoptists. This team provides a variety of different services at sites across the county.

Outpatient services are concentrated at the two main hospital sites - Gloucestershire Royal and Cheltenham General with general and specialist clinics being held at both sites. Other general outpatient services are provided at peripheral sites throughout the county with clinics being held on a less frequent basis.

Inpatient services are provided by Montpellier ward at Cheltenham General Hospital along with day case surgery in the Eyford Day Unit also at Cheltenham. There are 3 operating theatres equipped for eye surgery. In addition, day case cataract surgery is also available at Tewkesbury Hospital.

Contact details for all hospitals in the county that provide ophthalmology services are listed below:

Cheltenham General Hospital (CGH) Sandford Rd, Cheltenham, Gloucestershire GL53 7AN Main Switchboard: 08454 222222 Fax: 01242 272105

Cheltenham Eye Clinic: 08454 223200 Eye Appointments: 08454 224939/4938 (Fax: 08454 224936)

Gloucestershire Royal Hospital (GRH)

Great Western Road, Gloucester, Gloucestershire GL1 3NN Main Switchboard: 08454 222222 Fax: 01452 310737

Gloucester Eye Clinic: 08454 228468 Eye Appointments: 08454 224935/4937 (Fax: 08454 224936)

Eye Casualty Clinics are available: CGH – 2.00pm – 5.00pm – Monday to Thursday

9.00am – 12.30pm Fridays Telephone: 08454 223200

GRH – 9.00am – 11.00am – Monday to Friday

Telephone: 08454 228468

At weekends/outside the above hours please call the Switchboard 08454 222222 and ask for the

on-call ophthalmology doctor

Lydney & District General Hospital

Grove Road, Lydney, Gloucestershire GL15 5JF Tel 01594 598220

Tewkesbury Hospital

Barton Road, Tewkesbury, Gloucestershire GL20 5QN Telephone: 01684 293303 Fax: 01684 295887


Berkeley Hospital Marybrook Street, Berkeley, Glos GL13 9GL

Telephone: 01453 562000

Cirencester Hospital Tetbury Road, Cirencester, Glos GL7 1UX

Tel: 01285 884694

Moore Cottage Hospital Moore Road, Bourton on the Water, GL54 2AZ

Tel:01451 820228

Moreton District Hospital Hospital Road, Moreton-in-Marsh, GL56 0BS

Tel: 01608 650456

Stroud General Hospital Trinity Road, Stroud, Glos, GL5 2HY Tel:01453 562200

Whilst all consultants are general ophthalmologists each has an area of specific clinical interest. When recently asked, the consultants listed the following as their areas of special interest:

Mr Richard Caesar MA MB BChir FRCOphth Small incision cataract surgery, Oculoplastic reconstructive Surgery,

Oculoplastic cosmetic surgery, Lacrimal surgery

Mr John Ferris FRCOphth Small-incision cataract surgery, Paediatric Ophthalmology, Ocular Motility

Mrs Barbara Harney PhD FRCOphth

Medical retina including diabetic retinopathy and age-related macular disease

Mr Rob Johnston FRCOphth Vitreoretinal surgery, Medical retina, Small incision cataract surgery

Mr Nigel Kirkpatrick MD FRCOphth

Medical and Surgical Retina

Mr Graeme Mackintosh DO FRCS FRCOphth Cataract lenses: Accommodative, multifocal, aspheric, Refractive Surgery: Lasik, Lasek Phakic Implants (ICL, Artisan/Artiflex), Corneal Transplantation/Intacs. Ferrara rings

Oculoplastics and cosmetic surgery

Prof Andrew McNaught MD FRCOphth Glaucoma

Mr Quresh Mohamed BM, BSc(hons), FRCOphth

Medical retina including age related macular disease and diabetic retinopathy, Ocular inflammation & uveitis, Small incision cataract surgery.

Mr James H Nairne MA MB BChir FRCOphth FRANZCO FRACS

Glaucoma

Mr Nicholas C Price FRCOphth (current Clinical Director of Ophthalmology) Cataract, Corneal Surgery

Dr Peter Scanlon MD FRCP DCH DRCOG DO MRCOphth

Medical retina, Diabetic retinopathy


Further information about the ophthalmology department and its staff can be found on the ophthalmology page within the Gloucestershire Hospitals website (www.gloshospitals.nhs.uk)

Private Options:

For patients that would rather see an ophthalmologist privately there are a number of different options available within Gloucestershire. Contact details for the various hospitals/organisations are listed below:

ACES/CESP (Consultant Eye Surgeons Partnership) Lansdown Lodge Lansdown Road Cheltenham GL51 6QL Tel: 01242 521919 Fax: 01242 253816 or visit their website at www.aceseyesurgeons.co.uk

Nuffield Hospital -Cheltenham

The Cheltenham and Gloucester Nuffield Hospital Hatherley Lane Cheltenham Gloucestershire GL51 6SY Tel: 01242 246500 Fax: 01242 246501 or visit the Nuffield hospital website (www.nuffieldhospital.org.uk)

Capio Winfield Hospital - Gloucester Tewkesbury Road, Longford Gloucester GL2 9WH Tel: 01452 331111 Fax: 01452 331200 or visit the Capio website (www.capio.co.uk/Hospitals)


GUIDELINES FOR CATARACT DIRECT REFERRAL

May 2005

In Gloucestershire we have been fortunate over the years to have developed excellent relationships between the healthcare professionals and administrators involved in the provision of eyecare. This has enabled Gloucestershire to be one of the leading areas in the country for pioneering the development of eye care services. Optometrists have also been developing their role as Primary Eyecare Providers. June 2005 marked another step in that process as we widened the Direct Referral Scheme for Cataract to cover all referrals where cataract is the major or significant reason for the loss of vision.

Criteria for Referral

Patients will be monitored in the community as their cataracts develop until they reach the point where their vision is significantly affected. The referral criteria are:

1. 6/12 or worse in either eye. 2. Where the acuity is better than 6/12 but is seriously affecting the visual

performance of the patient then referral is permissible, so long as clear reasons for the referral are stated (e.g. Driving). Responsible referral is key to the success of the scheme.

The Gloucestershire Referral Procedure

1. Fast track Referral

The Fast Track Referral Scheme will continue to offer an efficient user-friendly pathway for all patients with simple cataract. Patients must agree to proceeding with surgery should it be offered. Fast track referral is available at Gloucester (GRH) or Cheltenham (CGH) hospitals only. A referral fee will be paid. Optometrists must be registered with the PCT to be able to refer directly.

2. Referral to a general clinic

Patients with significant cataract but with ocular co-morbidity or significant secondary issues will also be referred directly but into a general clinic rather than the cataract fast track clinic. Referral is to Gloucester or Cheltenham or any community hospital clinic as requested. However where the appointment is offered is ultimately the decision of the ophthalmologists. A referral fee will be paid.

3. Conventional GLOS1 Referrals

Patients who need to be assessed by an ophthalmologist but where the primary reason for referral is not cataract, please continue to refer via the GP on a GLOS1 or referral letter. No fee will be paid.

All Direct referral forms are to be sent to either the Central booking office at Cheltenham as is the case now. A fee will be paid for all direct referrals and claimed in the normal way on the relevant claim form. An audit trail must be kept within the practice. No fee will be paid for non-direct referrals via the GP. Referrals will be audited to ensure that the present high quality of referral is maintained.


For your information ophthalmology consultants have clinics at the following hospitals

Mr N Price CGH, Cirencester, Evesham, Moreton-in-Marsh

Mr N Kirkpatrick CGH, Cirencester, Bourton-on-the Water

Mr A McNaught CGH, Evesham, Tewkesbury

Mr G Mackintosh GRH, Stroud

Mr J Nairne GRH, Lydney

Mrs B Harney GRH, Tetbury, Berkeley

Mr J Ferris GRH, Stroud, Tetbury

Mr R Johnston CGH, GRH, Stroud

Mr R Caesar CGH, GRH, Tewkesbury

Dr P Scanlon CGH

Mr Q Mohamed GRH, CGH

All Cataract Referral is to be via the Community Optometrist.

It is intended that all referral for cataract will be by the community optometrist. If a patient goes to see their GP having noticed a reduction in their vision and their GP suspects that this is due to cataracts, then the patient will be given a letter of referral and advised to see their optometrist/OMP.

The New Referral Forms

The cataract form (version May 2005) is available on disc at optometry practices or can be downloaded from the LOC website (www.glosloc.co.uk). Alternatively a paper copy is available by contacting Nick Price’s Secretary on 08454 222524.

The GP is sent a copy of the referral for reference and information only. No response from the GP is required.

Two copies go to the hospital; one for the ophthalmologist and one for audit.

One copy is kept by the optometrist.

Fee Claim

The Direct Referral Claim form is completed for each referral and submitted to Carol Doelman at the Victoria Warehouse tel. 01452 300222 Ext. 2666. Again, claim forms may be downloaded from the LOC website or from Carol Doelman direct.

Registration for Cataract Scheme

All optometrists need to be registered to refer directly. This can be done by contacting Lesley Phillips on 01452 300222 ext 2601.


Guidelines for referring patients with age-related macula disease who are likely to benefit from cataract surgery

It is recognised that there will be a significant number of patients who develop cataract who also have a degree of age related macular changes. These guidelines relate to the co-morbidity of cataract and AMD without the presence of any other ocular co-morbidity and are designed to help optometrists make accurate and appropriate referrals.

The guidelines are based on the recommendations from a prospective study (Armbrecht et al. 2000, 2003) of 187 patients with and without AMD undergoing cataract surgery. The results of the study showed that, for certain combinations of cataract and AMD, there were improvements either in specific aspects of visual function and/or vision related quality of life. Cataract extraction in this group of patients improves both visual acuity and contrast detection.

Referral recommendations

Referral is recommended even if there is better vision in the fellow eye so that the potential for preserving binocular vision can be assessed.

Age related macular degeneration

Mild Moderate Severe Mild Yes 1 No 2 No 3

Moderate Yes 4 Yes 5 Yes 6

Cataract Severe Yes 7 Yes 7 Yes 7

The table below relates to the super-scripts in the above table and is a summary of the improvements likely to occur in visual function and vision related quality of life following cataract surgery.

Visual function Quality of life

1 Dist VA; Near VA; CS with glare Reading small print & newspapers/books

2 None likely Reading small print

3 None likely None likely

4 Dist VA; Near VA; CS with and without glare

Trouble with vision, reading small print, doing fine handwork

5 Dist VA; Near VA; CS with and without glare

Trouble with vision, reading small print, doing fine handwork

6 Insufficient data Possible improvement in CS

7 Cataract surgery is indicated when the opacity precludes adequate fundal examination and treatment of retinal lesions that are likely to progress and cause progressive vision loss if untreated.

If there is moderate cataract or greater, with symmetrical maculopathy and a poor outcome of previous cataract surgery, cataract surgery may not be advisable.


Definitions of AMD severity (derived from the International Classification of ARMD)

“Mild”

Any number of only hard drusen, fewer than 20 intermediate or soft distinct drusen, or fewer than 10 large soft indistinct drusen involving less than 25% of the macular region and/or granular pigmentary changes.

“Moderate”

20 or more intermediate or soft distinct drusen, or more than 10 soft indistinct drusen involving more than 25% of the macular region and/or pigmentary changes larger than 63µm.

“Severe”

Geographic atrophy (severe “dry”) or neovascular maculopathy (severe “wet”).

References

Armbrecht AM, Findlay C, Kaushal S, Aspinall P, Hill AR, Dhillon B.Is cataract surgery justified in patients with age related macular degeneration? A visual function and quality of life assessment.Br J Ophthalmol., 2000;84:1343-1348

Armbrecht, AM, Aspinall PA, Dhillon B. Cataract surgery in the patient with age-related maculopathy and degeneration.Comp Ophthalmol Update. 2003;4(1):17-24

Armbrecht AM, Findlay C, Aspinall P, Dhillon B, Hill AR.Cataract surgery in patients with age-related macular degeneration. One-year outcomes.J Cataract & Refractive Surgery. 2003;29(4):686-693


Gloucestershire Ophthalmology Service: Cataract Referral Form The form is divided into three sections:

Part A: White To be completed by the referring optician

(Four copies) Two for Ophthalmologist, One for GP, One for Optometrist

Part B: Yellow To be handed to the patient.

Please send referrals to: Central Booking Office

Second Floor, Riverside House

College Baths Road,

Cheltenham, GL53 7QB

Guidelines for Direct Referral of Cataract Patients Aim

• To provide an efficient service to patients who have visual impairment resulting primarily from cataract.

• We hope that the use of this cataract referral form will improve the cataract service and reduce the total number of steps that

most patients need to go through between initial recognition of cataract by the optometrist and discharge following surgery.

• Patients will be allocated to either a cataract clinic or a general ophthalmology clinic depending on the information provided on

this form.

Which Patients are Suitable for the Direct Optometrist Referral into the Fast Track Clinic?

• Patients with visual impairment which is principally due to uncomplicated cataract.

• If they have ocular hypertension or mild stable glaucoma, diabetes with no retinopathy, or trivial macular degenerative change.

• The patient should have expressed a willingness to proceed with surgery, if it is offered.

Which Patients need to be referred to a General Clinic?

• Patients who are unsure about surgery or who have other significant ocular or other problems where there is a lower chance of

immediate listing should be referred to an ophthalmologist on the same form but specifying that they are to be seen in a general

clinic.

Referral Criteria

• Any patient whose corrected VA is 6/12 or below in either eye should be referred to an ophthalmologist.

• Patients who have vision better than 6/12 but with significant visual impairment resulting from cataract and are experiencing a

degree of difficulty with normal day to day activities (including driving) should be referred.

• Any patient whose VA has dropped dramatically or prescription has changed rapidly in the last 6-12 months as a result of

cataract should be referred.

Referral Procedure

• All patients are to be offered “Patient Choice” of where they wish to be referred and their decision indicated on the referral

form.

• Optometrist should complete form A (white, four copies), ask the patient to sign it, and forward two copies (one for audit) to the

appropriate Hospital. An appointment within Gloucestershire will be issued on the basis of the optometrist referral either for a

Fast Track Clinic or a Routine Clinic according to that specified on the referral form. When requesting a routine appointment,

please indicate patient preference for a general appointment at CGH/GRH or a general clinic appointment in a community

hospital.

• The Optometrist should send a copy of the completed form to the GP for information only.

• The Optometrist keeps one copy of the form for their own records.

• Optometrist should sign and give the patient a copy of the Cataract Information Sheet C (yellow) and the RNIB Cataract

booklet.

The Fast Track Cataract Clinic

• An ophthalmologist will assess the patient and if surgery is recommended they will receive information and counselling.

Biometry will also be performed at the first visit.

• The patient will be given an indication of when they are likely to have surgery.

• Following the patient’s first clinic appointment some will be considered for a telephone pre-assessment prior to surgery,

whereas others may be required to attend a pre-assessment clinic at the hospital.

General Clinic

• Where there is significant co-morbidity then patients will be fully assessed and counselled before surgery is offered.


Gloucestershire Ophthalmology Service: Cataract Referral Form Optometrist/OMP Copy

Part A: For completion by optometrist

Patient details

Name: ___________________________________ D.O.B: __/__/__ Male � Female �

Address: _______________________________________________________________________________________

______________________________________________________________ Postcode: ________________

Telephone: Home: _________________ Work: _________________ Occupation: _________________

Referring Optometrist General Practitioner:

Name: ________________________________________

Practice Name: __________________________________

Address: _______________________________________

_______________________________________

Postcode: _____________________

Telephone: ____________________

Patients Visual Status Right Eye Left Eye Date

6/4 6/5 6/6 6/9 6/12 6/18 6/24 6/4 6/5 6/6 6/9 6/12 6/18 6/24 Current Corrected V/A

6/36 6/60 3/60 2/60 1/60 PoL NPL 6/36 6/60 3/60 2/60 1/60 PoL NPL

Current Refraction sph axiscyl axis sph cyl axis

Prism Base Prism Base

6/4 6/5 6/6 6/9 6/12 6/18 6/24 6/4 6/5 6/6 6/9 6/12 6/18 6/24 Previous V/A

6/36 6/60 3/60 2/60 1/60 PoL NPL 6/36 6/60 3/60 2/60 1/60 PoL NPL

Previous Prescription sph cyl axis sph cyl axis

Cataract Present Yes / No Yes / No

Previous cataract Surgery Yes / No Yes / No

Name of Hospital

Patient definitely wants surgery Yes � Patient’s Preferred Choice ____________________

Patient appointment for: Cataract Fast Track Clinic � CGH � GRH � (Within Gloucestershire)

General Clinic � CGH � GRH � General clinic at _______________________________

Patient Signature:__________________________Optometrist Signature:_________________________Date: ____/___/____

May 2005-Version1-copyright © Glos. Hospitals NHS Foundation Trust

Medical History

Diabetes �

Hypertension �

Heart Disease �

Lung Disease �

Stroke �

Other …………………………

Ophthalmic History

� Eye Drops-specify:

� Cataract surgery

� Other surgery-specify:

Significant Ocular Pathology

Glaucoma �

Age Related Macular Changes �

Retinal Detachment �

Diabetic Retinopathy �

Traumatic Injury �

Amblyopia/Squint/Phoria � Other

Further Comment


ACTION ON CATARACTS: CLAIM FORM Name of Optometrist: Practice Stamp: Contact telephone number: Please indicate whether you are working at this location as a locum: YES / NO Date of assessment: Patient's full name: Referral form number: Patient's date of birth: Please indicate to which Cataract Clinic the patient was referred: Cheltenham General Hospital � Gloucestershire Royal Hospital � Declaration: I declare that: -

• I am registered to take part in the Action on Cataract Project

• I have examined and referred the above named patient in accordance with all guidelines and referral protocols established by the Gloucestershire Ophthalmology Service.

• the information provided is accurate to the best of my knowledge and belief Signed………………………………… Date………………………………. ……………………………………………………………………………………………………………………… Notes: 1. Claim forms to be returned to:- Optical Payments Team Gloucestershire Health Authority Victoria Warehouse The Docks GLOUCESTER GL1 2EL 2. Payments will only be made to normal contract accounts. 3. Claims for the proceeding six month period (i.e. April to September or October to April) must be

received within 10 working days of the end of that period

FOR OFFICE USE ONLY:- � Claimant registered for Action on Cataract Project? YES/NO

� Service provided within previous six month period? YES/NO

� Claim received within 10 working days of the end of the relevant six month period? YES/NO

Fee of £37.50 authorised? YES/NO Initials……………. Date……………

Gloucestershire Health Authority


Cataract Choice

In order to adhere to current Government policy, when making an NHS referral, optometrists are required to offer patients a choice of referral centres from an approved list. As optometrists we have worked closely with our PCT to adhere to Government policy and extend the choice of approved providers for patients with cataracts. We wish to do this in such a way that it enables patients to make an informed choice without adding greatly to the workload of the optometrist. To this end the following guidelines are set out to facilitate the referral process

1. The criteria for referral, the referral form and the ‘Advice to Patient’s’ booklet remain the same. 2. Patients should be informed of the six providers to whom they can be referred and general information given.

However, where patients are already being treated within the ophthalmology department in Gloucestershire it is strongly recommended they stay with their consultant within the county.

3. If patients want more information with regard to the service provided by the different locations before making a

choice, then they should be given the telephone number of the Gloucestershire Choice Support Service on 01285 884597. It is then their responsibility to find out the information they require and to make their choice. It is also their responsibility to inform their optometrist of the choice they have made in order that the referral can be processed.

4. The referral form is completed in the normal way but specifying the patients preferred choice. It is then forwarded to

the address shown on the table below. 5. A claim for the referral fee is made in the normal way.

Trust name Address for referrals Tel number Gloucestershire Hospitals NHSFT Central Booking Office

Second Floor Riverside House College Baths Road Cheltenham, GL53 7QB

08454 222 222

United Bristol Healthcare NHST Medical Records Department Bristol Eye Hospital Lower Maudlin Street Bristol BS1 2LX

0117 928 4746

Oxford Radcliffe Hospital Patient Appointments Bureau John Radcliffe Hospital Headley Way, Headington Oxford OX3 9DU

0845 330 8888

Swindon & Marlborough NHST Ophthalmology Dept Great Western Hospital Marlborough Road Swindon Wiltshire SN3 6BB

01793 604 853

Hereford Hospitals NHST Booking Centre Hereford Hospitals NHS Trust County Hospital Union Walk Hereford HR1 2ER

01432 355 4444 and ask for the Booking Centre

Worcester Acute Hospital Ophthalmology Dept Aconbury West Worcester Royal Hospital Charles Hastings Way Worcester WR5 1DD

01905 760006 (automated number) Extn 33391

An information leaflet has been produced that can be given to patients. This can be downloaded from the LOC

website www.glosloc.co.uk.


Management of Wet Age-related Macular Disease (AMD) and Rapid Access Referral

We are delighted to inform you that photodynamic therapy (PDT) is now available within the county for the treatment of some forms of age-related macular disease. Previously, patients fulfilling the guidelines for this treatment have traveled to Bristol or further afield. We are taking this opportunity to streamline our management of all patients with wet AMD.

Patients with exudative AMD have a more rapid onset of symptoms than those with the dry form. They notice central visual loss often accompanied by distortion developing over the course of a few days or weeks. Distortion may be the earliest sign. Patients may not notice early symptoms when only one eye is affected and it is not unusual for them to present at a late stage with their first eye.

At present, two main forms of treatment are available. Conventional thermal laser treatment has been used for many years and is still appropriate for small neovascular lesions situated well away from the macular centre. Very few lesions fulfill these criteria. In PDT, a photosensitive dye is infused and the stained neovascular membrane treated using a cold laser. A wider range of lesions respond to this therapy. Fluorescein angiography is used to determine whether a lesion falls within the NICE guidelines for treatment and which therapy would be most appropriate. Unfortunately, there are still a large number of patients with wet AMD who do not fall within NICE guidelines for treatment and for whom there will still be no effective treatment available on the NHS at the present time.

As treatment very rarely leads to an improvement in vision and often simply reduces the extent of eventual visual loss, it is very important that patients should be seen as early as possible in the course of the disease process and ideally within a few days of onset of symptoms. In order not to overload the service and to prevent disappointment, it is also important that only those patients with any hope of benefiting from the treatment should be referred urgently. As most patients are referred via their optometrists, a rapid access referral system has been introduced to allow optometrists to refer directly. A copy of the wet AMD referral form is enclosed with this letter; it also details the referral criteria. Patients living on the east of the county need to be referred to Cheltenham General Hospital and those patients living on the west are to be referred to Gloucestershire Royal Hospital. If it is possible to fax a referral to the central booking team, this would be preferable, alternatively, a hard copy of the referral form can be sent to the Central Booking Office at Riverside House, Cheltenham General Hospital. Please ensure you retain a copy of the referral for your own records and send a copy to the patient’s GP.

On receipt of the referral, the patient will be contacted directly and then assessed in a specialist “retinal and distortion” clinic where fluorescein angiography will be available. If patients meet the criteria for PDT, they will be transferred for treatment at Gloucestershire Royal Hospital. A copy of the post treatment report will be sent to you, if indicated on the referral form that the patient has agreed to this.

Copies of the referral form can be downloaded from the LOC website - please see our forms and leaflets to download page (www.glosloc.co.uk).


Gloucestershire Ophthalmology Service: WET AMD RAPID ACCESS REFERRAL FORM

For completion by Optometrist Patient details Name: ______________________________ _______ Date of Birth: ___/___/___ Male Female

Hospital No (if known) _________________________

Address: ____________________________________________________________________________________

__________________________________________________________ Postcode: _________________________

Telephone: Home: ______________________ Work: __________________ Occupation: ____________________

Referring Optometrist General Practitioner

Name: ____________________________________________

Practice Name: _____________________________________

Address: __________________________________________

_________________________Postcode: ________________

Telephone: ________________________________________

GLOUCESTERSHIRE HOSPITALS NHS FOUNDATION TRUST AMD Rapid Access REFERRAL FORM – VERSION 2 – Oct 2006

AFFECTED EYE: RIGHT �� LEFT ��

PREVIOUS HISTORY IN EITHER EYE Previous AMD Right � Left �

Myopic Right � Left �

Other: Right � Left �

Referral Guidelines PRESENTING SYMPTOMS IN AFFECTED EYE (one answer must be ‘yes’) Less than 3 month history of:

1. Visual Loss Yes � No �

2. Spontaneously reported distortion Yes � No �

3. Onset missing patch / blurring in central vision Yes � No �

FINDINGS Corrected VA (must be 6/60 or better in affected eye) 1. Distance VA Right Left

2. Near VA Right Left

3. Macular drusen (either eye) Right � Left �

In the affected eye ONLY, presence of macular:

4. Haemorrhage Yes � No �

5. Subretinal fluid Yes � No �

6. Exudate Yes � No �

CURRENT REFRACTION: Distance: R …………………………… L ……………………..……… Date: ……..………… Near: R …………………..…….…. L …….…..……………..…...

OTHER COMMENTS:

FAX TO: 08454 224936

I request that my referring optometrist receives a report from the Hospital Eye Department: Yes � � � � No ��

Patient’s signature: Print name:

Optometrist’s signature: Print name: Date: / /

Central Booking Office: Second Floor, Riverside House, College Baths Road, Cheltenham, GL53 7QB

Patients will be contacted within 48 hours of receipt of this

referral, Monday to Friday and an appointment will be

sent.

Copy sent to GP: Yes � � � � No � � � �

GOC No: ________________________


LOW VISION

LVL, RVI and CVI

There are many different organisations throughout the county providing help and support to visually impaired people. Recent changes in the way in which visually impaired people are identified should make it easier to access help from the appropriate agencies and referrals can now be made by optometrists.

The Letter of Visual Impairment or LVI has now been superseded by the Low Vision Leaflet or LVL. The LVL can be given by optometrists to any patient they feel would benefit from contact with the Sensory Impairment Team at Social Services. The patient can then complete the leaflet and send it to the Sensory Impairment Team themselves. Social services will not be providing copies of the low vision leaflets but it can be downloaded from the LOC website www.glosloc.co.uk.

Optometrists in both community and hospital practice can also make a referral to Social Services using an RVI (Referral of Visual Impairment). This may be useful for patients that are either not eligible or have declined registration at the present time or who have not seen an ophthalmologist that are struggling with day to day life due to a sight impairment.

The BD8 form for partial sight and blind registration has been replaced by the Certificate of Visual Impairment (CVI) which as before can only be completed by an Ophthalmologist. The terms partial sight and blind have been changed to sight impaired and severely sight impaired

Further information on the new terminology and all aspects of registration of sight impairment can be found on the Department of Health website www.dh.gov.uk.

Sensory impairment team - Gloucestershire Social Services

Social Services Helpdesk: 01452 426868 Fax: 01452 427359

The Sensory Impairment Team hold a “drop-in session” once a month for people with a visual impairment and their relatives. This is within the Ophthalmology Department at GRH – on the second Monday afternoon of every month (1.30 – 4.30pm). Further details can be obtained by telephoning the team on 01452 426387.

Low vision clinics - hospital service

Low vision clinics are held at Cheltenham General, Gloucestershire Royal, Cirencester and Stroud Hospitals. These clinics are run by the hospital optometry department and provide an assessment of visual needs, offer advice on ways to cope with sight loss and issue magnifying aids where appropriate. Most optical magnifying aids are provided to patients on a loan basis.

In order to access these low vision clinics patients need to be referred by their GP or must already be a patient within the ophthalmology department.


GCAB - Gloucestershire County Association for the Blind

This is a local charitable organisation that provide various means of support for the people with sight loss in the local community. Their services include a resource centre open 9am to 4pm Monday to Friday, a visiting service for registered visually impaired people, newsletters and members information groups.

For more information contact the GCAB on 01242 221170 visit the resource centre at 81

Albion Street Cheltenham GL52 2RZ or visit the GCAB website: www.glos-blind.co.uk

Forge Centre

The FORGE Centre is an independent local charity which has established a resource centre for visually impaired people in the Forest of Dean. As well as offering advice and support on coping with visual impairment they also offer a range of activities for the visually impaired including craft classes and gardening club.

For more information contact the Forge Centre on 01594 827711 or visit the Forge Centre

Website: http://beehive.thisisgloucestershire.co.uk

Forge Centre, Foxes Bridge Centre, Valley Road, Cinderford, Glos, GL14 2LJ

RNIB

There are around two million people in the UK with sight problems and RNIB (Royal National Institute of the Blind) is the leading charity offering practical support and information to anyone with a sight problem. Our pioneering work helps - not just with braille, Talking Books and computer training but with imaginative and practical solutions to everyday challenges.

For further information visit the RNIB website: www.rnib.org.uk


The Gloucestershire Glaucoma Project

The Glaucoma Project commenced in October 2002 when Gloucestershire Ophthalmology Service was funded by West Glos PCT to run a two year pilot project to develop the services for patients at risk of developing glaucoma in the county. This funding has subsequently been extended and the pilot has now reported results to the PCT. The Project Director is Professor Andrew McNaught (Consultant Ophthalmic Surgeon) and the Project Manager is Miss Lisa Collins (Countywide Head of Optometry).

The project aims to improve the quality of referrals for glaucoma from community optometrists, the main professional group that screen for the disease in the community. Community optometrists are required to undertake more rigorous examination of "at risk" patients, prior to referral to the hospital. This is aimed at reducing the number of false positive referrals, i.e. a patient having to come to hospital when they do not have glaucoma. A new Glaucoma Referral Refinement scheme was launched on 1st March 2003 for all community optometrists practicing in the Forest of Dean. This is the pilot group for the project and if this proves successful, it is anticipated the scheme will be rolled out to the entire county. The referral process allows the optometrist to refer patients direct to the ophthalmologist without the patient seeing their GP. This speeds up the waiting time for the patient and allows patients with glaucoma to be treated earlier.

The second part of the Glaucoma Project will evaluate the feasibility of hospital and community optometrists providing the follow-up examination of patients with suspect or early glaucoma i.e. the "low risk" groups. At present a large number of these patients have to return to the hospital for review, usually by an ophthalmologist. The pilot will allow us to determine if it is safe to transfer certain patients to an optometrist and also if the quality of care remains high. We are also keen to learn of the patient's experience and perceptions of this potential change in clinical practice.

This is an exciting and innovative project that will identify a robust, high quality and effective plan for the future delivery of care for patients with glaucoma in Gloucestershire.

If you are practising in the Forest of Dean please contact David Adams for details on how to register for this scheme.


Hospital Optometry Services

The Optometry service within Gloucestershire Hospitals NHSF Trust is a countywide service headed by Miss Lisa Collins. The main focus of the service is at Cheltenham General and Gloucestershire Royal Hospitals but clinics are also held at peripheral sites across the county including Tewkesbury, Cirencester, Stroud and Berkeley in support of the Ophthalmology Departments. Much of the work we do within the Hospital Optometry Department is to support and supplement the ophthalmology services including performing post-operative cataract examinations, glaucoma shared-care, diagnostic and paediatric refractions. However, we also offer a number of specialised services such as low vision clinics and complex contact lens fitting including scleral contact lenses. The department consists of a team of twelve optometrists, some of whom work on a part-time basis between the hospital and community.

If you have any queries relating to hospital optometry please contact the department on 08454 223203.

Diabetic Screening in Gloucestershire

The Diabetic screening service in Gloucestershire started screening in October 1998 and is spear-headed by Dr Peter Scanlon. The service is currently based at Cheltenham General Hospital and has 6 mobile units travelling out to GP surgeries across the county to screen patients suffering from diabetes, for any signs of diabetic retinopathy. The service currently has 22,000 diabetic patients on its register. All patients are dilated, unless there is evidence of contraindications, their vision is tested using LogMar charts and then high resolution digital retinal images are taken. Patients will be given some basic education on how diabetes can affect their eyes and they will be shown their own images. The images and patient data are then transferred to the diabetic eye screening central server within Cheltenham General Hospital, for analysis by a team of specialist graders. All grading is subject to a full and nationally recognised QA process, this helps reduce mistakes and un-necessary referrals. Patients with sight threatening diabetic retinopathy or other referable ocular pathology identified on the photographs are referred on to the ophthalmology clinics within the hospital eye service. The service aims to screen all diabetics on an annual basis. ‘Mop up’ clinics are held at both Cheltenham General and Gloucestershire Royal Hospital on an occasional basis to which patients who missed the session at their GP surgery are invited.

Further details of the service can be found on the hospital website www.gloshospitals.nhs.uk


Gloucestershire Primary Care Trust

Unit 14 Highnam Business Centre

Newent Road Highnam

Gloucester GL2 8DN

Tel: 01452 389400 Fax: 01452 389429

E-mail: [email protected]

Chief Executive: Jan Stubbings

Gloucestershire PCT was formed on 1st October 2006 and replaced the three former Primary Care Trusts in Gloucestershire (Cheltenham and Tewkesbury, Cotswold and Vale and West Gloucestershire).

The organisation serves a population of approximately 602,000 and covers the following district council areas: Cotswold, Cheltenham, Forest of Dean, Gloucester, Tewkesbury Borough and Stroud.

The PCT is made up of 83 GP Practices and 11 community hospitals. It also provides a range of community services such as podiatry, speech and language therapy, occupational therapy, district nursing and health visiting.

The PCT has a budget of £676 million for 2006/2007 (and a forecast budget of £734m for 2007/2008) and currently employs approximately 3,600 members of staff.

The main role of our PCT is to:

• engage with the local population to improve health and well being • commission a comprehensive and equitable range of high quality, responsive and

efficient services and; • directly provide services where this gives best value.

As a countywide organisation, the PCT recognises how important it is to retain a local focus so that the valuable working relationships that have been built with primary care, local councils and a wide range of committed community and voluntary groups continue to be strengthened. The PCT believes that its future success will depend on this co-operation and joint working.

As an LOC we continue work closely with our PCT to negotiate and regulate General Ophthlamic Services provision within the county.


Three Counties Optometry Society

Herefordshire Worcestershire

Gloucestershire

Background As an LOC we have appreciated the valuable input of the Three Counties Optometric Society in providing high quality continuing education in a local context and also a forum for communication between Gloucestershire optometrists. Three Counties Optometry Society has been established for over 30 years and has provided academic lectures and a meeting forum for its members every year. The Society usually arranges 5 or 6 lectures each year between September and March and speakers range from local ophthalmologists to nationally and internationally renowned optometric speakers. Lectures cover a diversity of topics including dispensing and contact lens matters, orthoptic and ophthalmological pathology. Most subjects covered are suggested by the members to meet local or general interest needs. The Society is registered with Vantage Technology as a CET provider and most lectures are awarded 1.5 CET credits. The Society is open to all optometrists, dispensing and contact lens opticians. Annual membership fee is currently £35 (or £10 per meeting for occasional visitors) and renewal/new member fees are taken during August to start the season in September.

Venue We meet at Redwood Education Centre at Gloucester Royal Hospital. The centre has up-to-date multi media presentation equipment and there is ample parking on site. Meetings start at 7.00pm for refreshments and chat, with the lecture commencing at 7.45pm.

Programme of lectures Please see the LOC website www.glosloc.co.uk for the latest programme of lectures.

Contacts Committee members are: Graeme Lowcock [email protected] tel.01684 850212 Mary Russell [email protected] Laura Belverstone [email protected]

Documents

GLOC Pack Version1 Feb 2007 - glosloc.co.uk