Eye patients face delays as new health guidelines on glaucoma tests puts pressure on York Hospital (From York Press)

Eye patients face delays as new health guidelines on glaucoma tests puts pressure on York Hospital

9:48am Thursday 1st October 2009 in Search By Mike Laycock, Chief reporter

A NEW guideline intended to help save sight has led to York Hospital’s eye clinic being “swamped” by an extra 1,000 patients.

The guidelines for the treatment of suspected glaucoma were introduced in April by the National Institute for Health and Clinical Excellence (NICE).

Tim Manners, the hospital’s clinical director for ophthalmology, said today the guideline had resulted in an increase of up to 50 per cent in suspected glaucoma referrals by opticians.

He said this had meant approximately 1,000 extra outpatients over the last six months, causing “severe problems”.

A charity for the blind warned delays in seeing patients suffering from the eye condition could result in some needlessly losing their sight.

The Royal National Institute of Blind People (RNIB) said a recent report from the National Patient Safety Agency had stated more than 100 patients had suffered unnecessary sight loss as the result of delays in follow-up appointments. “Many more patients with glaucoma could needlessly lose their sight,” warned Eye Health Campaign manager Barbara McLaughlan.

She said there had already been problems in eye clinics prior to the NICE guidelines, adding: “We believe the long-standing capacity problems need to be addressed as a matter of great urgency.”

Mr Manners said: “An unexpected and unplanned for increase of many thousands of referrals has caused severe problems with an already overburdened ophthalmology service nationwide, and York is no exception.”

He revealed it was likely some patients would have to be seen in the private sector if the trust was to meet its target of seeing all new patients within 11 weeks of referral.

He said many opticians had only referred cases with significant risk of disease previously, but as a result of the guidelines, they had been advised by their professional body to cease any monitoring, and simply to refer any patient with a single reading of even slightly raised IOP (intra-ocular pressure in the eye).

“Many of the patients referred will also need long-term review, although most will not have glaucoma,” he said.

He said York Hospital had the advantage of having recently-built infrastructure, so the service could be expanded without new building, and by the end of the year, significant extra capacity would be available.

“Opticians who specialise in hospital work have been recruited and are currently being trained to help with this new and extra work under consultant ophthalmology supervision.”

In the meantime, he hoped progress was being made at a political level to address the unforeseen consequences of the guidelines.

Acomb optometrist Ruth Perrott said she had referred many more patients following the introduction of the new NICE guidelines.

She said she welcomed the clarity and structure provided by the new guideline, on the diagnosis and management of chronic open angle glaucoma and ocular hypertension, however, she did not believe the guideline reflected the existing work or expertise of optometrists in patient monitoring and diagnosis.

Concern mounting over appointments

ONE eye patient told today how she had been affected by the new NICE guidelines.

Sue Nelson, 52, a Press columnist, from Wheldrake, said her eye pressure readings had been the same for years with no adverse effects, but in June she had had to be referred to the hospital for further tests because of the new guidelines.

She said after nine weeks, she had still been waiting for an appointment, but when she had rung the appointments section to check what was happening, she was told it had been “completely swamped” and staff had no idea when it could give her an appointment.

She said she was told consultants might be asked to set up additional clinics to cope, but it was not known if this would be possible because they were already busy. Mrs Nelson said she was much more concerned about people other than herself who might, for example, be referred after having pressure readings taken for the first time or whose readings had suddenly got higher.

“Whatever your situation, you’re caught in the backlog and obviously there are some whose need might be greater than others,” she said.

“Glaucoma can be treated successfully if symptoms are caught early. If they’re not, it can lead to blindness.

“This seems to me to be yet another case of guidance being handed down from on high without any understanding of the impact it will have on our hospitals and the staff who have to deal with it, not to mention the patients themselves.”