From 1st January 2010

In response to theNICE guidelines CECPCT now has a Glaucoma Referraal Refinement scheme which pays for a repeat of IOPs or visual field where the initial results are suspicious

IOP refinement process

When the initial IOP is above 21mmHg during a Sight Test (using whatever instrument that you normally use)    you can repeat the IOP imediately using either  a Goldmann or a Perkins Tonometer. If the IOP is still over 21mmHg then you should refer as per NICE guidelines. If the IOP is 21mmHg or under, you do not need to refer unless there are other signs suggestive of Low/Normal Tension Glaucoma.

NOTE the fee for IOP refinement assumes that the IOP will be repeated whilst the patient is still  there following the first sight test. Whilst  there is no objection to repeating the IOP on a different day if it is not possible to repeat the IOP  imediately this is probably considerably less economically viable for most practices and an unnecessary inconvenience for most patients.

Visual Fields refinement process

If you get a suspicious visual field result during a sight test (using whatever field screener and test pattern that you normally use) you may repeat the visual field test on a different day. The repeat test may be either a Supra Threshold test of at least 60 points or a SITA 24-2 threshold programme (or equivalent). If the repeat test shows a consistent field defect in the same area of the retina as the original plot then the patient should be referred. Obviously if the field loss is of long standing and/or previously investigated and is unchanged  then  there would be no need to refer. If on the repeat test, there is still a defect but not in the same area of the field as on the first occasion then  the results are inconsistent and  there is no need to refer.

IOP and Visual Fields refinement process

If IOP is above 21mmHg in either and there is a suspicious visual field defect in the same patient then the IOP should be  repeated initially (ideally imediately following the sight test). If the IOP is consistently above 21mmHg then there is no need to repeat the Visual Fields and the patient should be referred for raised IOP as per NICE Guidelines. However, if IOP on Goldmann/Perkins if 21mmHg or less then you should ask th epoatient to return on a different day for repeat Visual Fields and proceed as per the VF refinement process above. In the last case, the fee for both repeat IOP and repeat VF would be paid

Paperwork

The protocol/procedure document, the report/referral/fee claim form are all available to download on the right hand side of this page.

There is also a Word Template version of the referral form which can be filled in on a PC running Word (2003 or newer). The template is protected but can be unlocked and customised to your practice address etc if you know how to. The password is "glaucoma".

Training and Acreditation

There is no need for formal accreditation to take part in this scheme. The skills involved are within the core competencies for all registered optometrists.

However, we are aware that many optometrists may not have performed contact tonometry for some considerable time and so there are 2 optional training packages available for those who would like a refresher in any of the techniques involved

1) CD based lectures/video on Glaucoma, fields, Goldmann use an clibration etc These are provided by LOCSU and Cardiff Unviersity

2) Workshop on Goldmann use and calibration. These will run at a couple of locations in an evening.

Please contact Chris on 01270 376594 to get a code for the Cardiff university website and register for the CDs or to book   place on one of the local workshops

More detailed information is in the training info document on the right