Transcript Name of presentation

Tees Cataract Service
Julie Breen
LOC Chair and Tees Lead for the Cataract
Service
Email: [email protected]
Objectives
The objectives of the service are:
• To diagnose those patients who require cataract
treatment and check for other conditions
• To discuss the patients condition(s) with them
and options available
• Provide the patient with relevant information
• Refer patient directly following Choose and Book
procedures
Cataract Service
Optometrists, having performed an eye examination and identified a cataract
that is causing visual problems to a patient will provide the following service:
•
Explain what cataract treatment involves and discuss options with the
patient.
•
Obtain patient’s consent to proceed with referral for surgery.
•
Check fundii under mydriasis and record results on referral form.
•
Complete cataract referral form up to and including “disabilities” section.
•
Provide the patient with the Choice Booklet and telephone number of the
Choice Team, in order for the patient to discuss choice of provider and
arrange booking of their hospital appointment.
Cont/…
Cataract Service
•
To provide the patient with the RNIB Cataract Booklet or College of
Optometrist leaflet
•
Provide the lid hygiene/blepharitis advice leaflet and discuss the
importance of good hygiene
•
Where the patient has difficulty using the telephone to make an
appointment the Optometrist will contact the Choice team on behalf of
the patient during the consultation.
Fax referral form to CHOICE/MARS team within 24 hours
•
Co-morbidity precludes patients from referral via Direct Cataract referral and
must be referred in the normal manner using a GOS18.
Service description/care pathway
• Patients will attend for a cataract assessment with accredited
ophthalmic practitioners via self-referral, GP-referral or Optometrist
referral
• If the Contractor is unable to provide for the assessment the
Contractor, ophthalmic practitioner or other responsible person they
shall direct the patient to an alternative provider of the services.
• A GOS or private sight test will reveal the presence of cataract and
the examining ophthalmic practitioner will discuss with the patient
options for further assessment and or treatment to the patient and
make a referral in line with Choose and Book as necessary. If the
cataract is not presenting any significant visual or lifestyle
difficulties, then they will continue to be reviewed by the
ophthalmic practitioner in the normal way
Risk Factors
Discuss and document presence of the following risk factors:
• female gender - slightly increased risk
• age - cataracts present in approximately 70% of people age 85 years or older
• family history - heritability could be 48-59%
• presence of co-morbidities, e.g.
– chronic uveitis
– prior intra-ocular surgery, e.g. glaucoma filtration surgery or vitrectomy
• diabetes mellitus (DM)
• long-term use of systemic or inhaled steroids
• smoking
• excessive alcohol use
• previous eye trauma or surgery
• UV-B exposure
• dehydration or diarrhoeal crises
• irradiation
• extreme short-sightedness
• taking statins
Detailed visual history
Obtain a detailed visual history:
•
•
•
•
near and distance vision
past history of eye disease
binocular function
amblyopia
Patient questions?
Ask patient (suggested questions to ask):
• how cataract has affected their quality of life (QoL)
• whether the decline in visual acuity has precluded them from some
occupations, e.g. ask what they are no longer able to do or enjoy
• to describe their own near and distant vision under varied lighting
conditions
• whether they drive or not
• whether they take any medication that may increase the risk of
surgery:
– tamsulosin
– other alpha-antagonists
– anticoagulants
Ocular examination
Perform a thorough ocular examination to include:
• check for refractive errors by assessing acuity with and
without refractive correction
• assessment of pupil function
• measurement of intraocular pressure (IOP)
• slit lamp biomicroscopy of the anterior segment
• examine fundus for signs of retinal disorders
• evaluation of glare disability and reduced contrast sensitivity
• assess ocular motility and binocularity
• assess and categorise lens opacity
Please note...
It is important that optometrists do not assess
and refer patients already under the care of an
ophthalmologist (e.g. for another active ocular
condition). In such cases, the optometrist should
refer the patient back to the ophthalmologist
with a letter explaining the patient's current
visual difficulties.
Staff competencies
Qualified optometrist that has undertaken an
accredited training programme approved by
Hartlepool & Stockton CCG and South Tees CCG
and must be registered with the General Optical
Council. The nationally approved WOPEC
distance learning module is to be completed.
Population covered
• The geographical areas of Hartlepool, Stockton on Tees,
Middlesbrough and Redcar and Cleveland.
• The provider shall ensure that the patient is an eligible person
by verifying the patient’s GP before providing the enhanced
service.
• In order to qualify for a domiciliary GOS sight test, the patient
must fall into one of the NHS eligibility categories and be
unable to leave home unaccompanied. To be eligible for a
domiciliary cataract assessment under the service, the patient
must be able to travel to the treatment centre for treatment if
suitable transport can be provided, and be able to co-operate
with the procedure.