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Under a new protocol in the United Kingdom, optometrists there are referring patients directly to ophthalmologists for the first time. The new system, which is being closely followed by ophthalmologists and optometrists in other parts of Europe, is expected to reduce treatment delays and promote more efficient use of the time of general practitioners and ophthalmologists. Under the old system, patients would first go to their optometrist who would perform a sight test. If there was evidence of a cataract the optometrist would then refer them on to their GP, who would then refer them to an ophthalmologist.The new protocol is proving very popular, said Malcolm Gray, an optometrist and member of a national advisory group called "Action on Ophthalmology." "Patients' love it, because it saves them time, GPS like it, because it's less work in an area where they have little understanding," said Mr. Gray. The new system also reduces patient frustration, he adds. Under the old system, many patients who waited to see an ophthalmologist believed they were going to be cured because their GP often did not understand their condition, Mr. Gray added. "Sometimes patients waited three months to be told nothing could be done, except to register them as blind." He pointed to macular degeneration as a typical example. "97% of macular degeneration cases are untreatable. So in those cases it's important to direct the patient to low-vision specialists. But few GPs are sufficiently expert in eye conditions to decide if a patient's AMD can be treated or not. Under the old system nearly all AMD cases were referred to an ophthalmologist, taking up an enormous amount of time." Mr. Gray added that optometrists are also more aware than GPs about the particular subspecialties of certain ophthalmologists, which enables them to direct patients to the appropriate ophthalmologist. "We have some of the best surgeons in the world overworked because of the mundane tasks they have to do, while there are optometrists who could help to filter this out and make the system work better." Although the new protocol is confined to larger UK's health authorities, the system will be extended nationwide next year.The new rules have drawn the envy of Mr. Gray's colleagues on the continent. "The UK is leading the rest of Europe in this. The level of training in optometry in the UK is way ahead of the continent. I lecture on the continent on a regular basis and what the UK is doing in optometry is many years ahead. In terms of regulation also, UK optometrists have a far greater role in eye care than those on the continent. For example, optometrists in Germany are not allowed to use topical drugs. I have colleagues in France and Germany saying that this sort of measure is exactly what they need."The rules have also received a broad welcome from UK ophthalmologists. "Hopefully it will be more efficient," said Helen Seward, a former president of UKISCRS who practises at the Croydon Eye Unit. "I know from audits we've done in Croydon that when patients are referred by their optometrist, over 90% come to cataract surgery, but if they are referred by their GP it's about 75%. So we'll have more appropriate referrals," she said. But some say it is important for GP oversight to be maintained for the new protocol. "I think it is a positive development," said Dr. Paul Rosen, consultant ophthalmologist at Oxford Eye Hospital. "But we have to be careful about the new role for optometrists. In some cases optometrists receive co-managing fees from private hospitals, and this could influence referrals. It's important that the GP is kept informed." Mr. Gray notes that despite the increased role for optometrists, GPs still retain a pivotal role in the overall care of their patients. "GPs can intervene to stop treatment at any point," Mr Gray said. Helen Seward FRCS Malcolm Gray Paul Rosen |
