Hospital to Community: identifying the value of optometrists monitoring and managing chronic sight threatening eye disease in primary care.

End of project summary

We are as confident as we can be that primary care referral refinement services for wet age-related maculopathy (wet AMD), and monitoring services for glaucoma, using optometrists with higher professional qualifications, will dramatically reduce waiting times and waiting lists in the hospital eye service (HES) and release meaningful capacity in the HES including consultant ophthalmologist time. 

Many optometrists in Wales have the appropriate skills and level of qualification to deliver these primary care-based wet AMD and glaucoma services and there is a community of optometrists (that are appropriately qualified) in Wales that has the capacity to provide these services and is motivated to do so. 

We found using primary care enhanced optometry services (EOS) will not cost any more than current care, and if appropriately qualified optometrists are able to move to decision making, rather than data collection with their cases reviewed virtually by ophthalmologists, the cost is less and resource release in HES is greater. 

We found patients are as satisfied with the primary care services as they are with a hospital-based service and find it more convenient. 

Fundamental to the success of these services is: 

• ensuring the pivotal role of a coordinator is in place;
• having a clear road map for all stakeholders in place; 
• providing clear accessible information for patients; 
• ensuring appropriate resourcing is in place e.g., appropriate fees, information technology and related maintenance; 
• good communication between optometrists and ophthalmologists e.g., sharing patient records and appropriate feedback. 

If widespread changes in services are implemented, using routinely collected data and our model would enable commissioners to understand how the changes in resources may bring about ongoing improvements in services for patients.