The 2017 NICE guideline on glaucoma can be viewed by clicking the link below to the right.
Also available is the useful European Glaucoma Society Guidelines booklet.
Implications of NICE Guideline (NG 81) for optometrists working in Buckinghamshire
As you may be aware, NICE published a new glaucoma guideline on 1 November 2017. Some key points of this new guideline are:
- The threshold for referring patients with raised IOP and no other signs of glaucoma has increased to 24mmHg and above.
- The age criteria in the previous guideline (CG 85) no longer apply.
- NICE advises that patients should not be referred solely on IOP measured by non-contact tonometry.
Unfortunately, Milton Keynes CCG has not yet commissioned a repeat measures service; such a service would enable the funding of Goldmann-type tonometry measurement.
The view of LOCSU is that optometrists working in areas where no repeat measures scheme is in place should not be criticised for false positive referrals which are the result of a lack of commissioning.
Consequently, it is recommended that the following statement is included, if referrals are made based solely on a non-contact tonometry reading: “This referral is being made based on non-contact tonometry results, due to the fact that no repeat measures service has been commissioned locally”.
We have written to MKCCG, and copied to colleagues in the HES, so that they are aware that the high rate of false positive referrals for raised IOP that they may be seeing is the result of a lack of commissioning, and not related to the competence of primary care optometrists making the referrals.
Mid & South Bucks
In this area, we do have a glaucoma repeat readings service, but only 10 practices are currently involved in this. Ophthalmologists working in Buckinghamshire Healthcare NHS Trust have therefore agreed the following:
1. Those not in the scheme should now refer on IOP >= 24 mm Hg (instead of the previous threshold of >21 mm Hg), in the absence of any other signs.
2. Those in the scheme should modify the referral criteria as above, but also do not put people into the scheme now unless they are >= 24 mm Hg. Until the software is updated, this may mean ignoring prompts from the OptoManager software, and making their own decision on readings >= 24 mm Hg.