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Konstantakopoulou E, Varia J, Parmar J, Nathwani N, Hau S, Low WS, Edwards LA, Laber E, Bhalla M, Gazzard G, Jayaram H. Optometrist-delivered selective laser trabeculoplasty in the HES - a training protocol and early service evaluation. Eye (Lond) 2024:10.1038/s41433-024-03086-1. [PMID: 38702512 DOI: 10.1038/s41433-024-03086-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 03/05/2024] [Accepted: 04/11/2024] [Indexed: 05/06/2024] Open
Abstract
Over the last decade, the delivery of glaucoma care in the UK has changed dramatically, with more non-medical ophthalmic practitioners involved in the care of glaucoma patients. Optometrists and other non-medical professionals are now involved in the delivery of laser treatments in the Hospital Eye Service (HES), but there is currently no standardised national training framework for non-medical clinicians. Moorfields Eye Hospital and UCL's Institute of Ophthalmology have developed and delivered an education and training programme for the delivery of lasers, including Selective Laser Trabeculoplasty (SLT) by non-medical ophthalmic practitioners. The training programme is based on medical education principles, is informed by previous qualitative research into the role of ophthalmic practitioners in the delivery of laser treatments and is expected to have multidisciplinary benefits for ophthalmic healthcare. Clinical audit data indicate that optometrists can deliver safe SLT treatments, adhering to local protocols.
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Affiliation(s)
- Evgenia Konstantakopoulou
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and the UCL Institute of Ophthalmology, London, UK.
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK.
- Optometry Education, Moorfields Eye Hospital NHS Foundation Trust, London, UK.
- Division of Optics and Optometry, University of West Attica, Athens, Greece.
| | - Jay Varia
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and the UCL Institute of Ophthalmology, London, UK
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Optometry Education, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Janisha Parmar
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and the UCL Institute of Ophthalmology, London, UK
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Optometry Education, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Neil Nathwani
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and the UCL Institute of Ophthalmology, London, UK
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Optometry Education, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Scott Hau
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and the UCL Institute of Ophthalmology, London, UK
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Optometry Education, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Wing Shing Low
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Laura A Edwards
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Emma Laber
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Minak Bhalla
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Gus Gazzard
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and the UCL Institute of Ophthalmology, London, UK
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Hari Jayaram
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and the UCL Institute of Ophthalmology, London, UK
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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Gunn PJG, Read S, Dickinson C, Fenerty CH, Harper RA. Providing capacity in glaucoma care using trained and accredited optometrists: A qualitative evaluation. Eye (Lond) 2024; 38:994-1004. [PMID: 38017099 DOI: 10.1038/s41433-023-02820-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 10/02/2023] [Accepted: 10/30/2023] [Indexed: 11/30/2023] Open
Abstract
INTRODUCTION The role of optometrists in glaucoma within primary and secondary care has been well described. Whilst many studies examined safety and clinical effectiveness, there is a paucity of qualitative research evaluating enablers and barriers for optometrists delivering glaucoma care. The aims of this study are to investigate qualitatively, and from a multi-stakeholder perspective whether optometric glaucoma care is accepted as an effective alternative to traditional models and what contextual factors impact upon their success. METHODS Patients were recruited from clinics at Manchester Royal Eye Hospital and nationally via a Glaucoma UK registrant database. Optometrists, ophthalmologists, and other stakeholders involved in glaucoma services were recruited via direct contact and through an optometry educational event. Interviews and focus groups were recorded and transcribed anonymously, then analysed using the framework method and NVivo 12. RESULTS Interviews and focus groups were conducted with 38 participants including 14 optometrists and 6 ophthalmologists (from all 4 UK nations), and 15 patients and 3 commissioners/other stakeholders. Themes emerging related to: enablers and drivers; challenges and barriers; training; laser; professional practice; the role of other health professionals; commissioning; COVID-19; and patient experience. CONCLUSION Success in developing glaucoma services with optometrists and other health professionals is reliant on multi-stakeholder input, investment in technology and training, inter-professional respect and appropriate time and funding to set up and deliver services. The multi-stakeholder perspective affirms there is notable support for developing glaucoma services delivered by optometrists in primary and secondary care, with caveats around training, appropriate case selection and clinical responsibility.
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Affiliation(s)
- Patrick J G Gunn
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Simon Read
- School of Health and Social Care, Swansea University, Swansea, SA2 8PP, UK
| | - Christine Dickinson
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Cecilia H Fenerty
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Robert A Harper
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Centre for Applied Vision Research, City, University of London, London, UK
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Effectiveness and safety of VISULAS® green selective laser trabeculoplasty: a prospective, interventional multicenter clinical investigation. Int Ophthalmol 2022. [DOI: 10.1007/s10792-022-02617-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Abstract
Purpose
To evaluate the effectiveness and safety of Selective Laser Trabeculoplasty (SLT) with the SLT mode of the VISULAS® green laser in patients with primary open-angle glaucoma (POAG).
Methods
This prospective, interventional multicenter clinical investigation included patients with POAG who either needed a treatment escalation because the individual intraocular pressure (IOP) target was not met or treatment initiation and had an IOP ≥ 17 mmHg at baseline in the study eye. The study was conducted in five research centers across Germany. Approximately 100 laser applications were delivered to 360° of the trabecular meshwork. Glaucoma medications were not modified during the 3-month follow-up to allow evaluation of the sole effect of VISULAS® green with SLT. Efficacy outcomes were postoperatively absolute and relative IOP changes at 1 and 3 months. Safety outcomes analyzed the rate of intra- and postoperative adverse events.
Results
Thirty-four eyes of 34 POAG patients were included. The overall mean number of preoperative glaucoma medications was 2.2 ± 1.4 in 29 treated eyes, 5 eyes were treatment naïve. Mean baseline IOP (mmHg) was 21.0 ± 2.69 and was reduced by − 3.53 ± 3.34 [95% CI − 4.61; − 2.45] and − 3.59 ± 3.41 [95% CI − 4.64; − 2.53] at the 1- and 3-month follow-up, respectively (p < 0.0001), with 48.5% of cases achieving a ≥ 20% IOP reduction at 3 months [95% CI = 30.8%; 66.5%]. The mean relative IOP reduction was − 16.4% and − 16.3% at 1 and 3 months, respectively (p < 0.0001). Potentially device- or procedure-related adverse events were mild to moderate and included 3 postoperative IOP-spikes and 6 reports regarding eye pain and discomfort. All were resolved without sequelae.
Conclusions
SLT performed with the VISULAS® green laser achieved clinically significant additional IOP reductions in medically treated as well as in treatment naïve eyes with POAG and there were no relevant safety issues. The results are comparable to other reported SLT studies.
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Selective laser trabeculoplasty (SLT) performed by optometrists-enablers and barriers to a shift in service delivery. Eye (Lond) 2021; 36:2006-2012. [PMID: 34389819 PMCID: PMC8362647 DOI: 10.1038/s41433-021-01746-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/22/2021] [Accepted: 08/03/2021] [Indexed: 11/08/2022] Open
Abstract
Background/objectives To explore the acceptability, training requirements, enablers and barriers of optometrist-delivered SLT. Subjects/methods Optometrists, fellowship and consultant grade ophthalmologists, hospital managers and patients were interviewed using pre-defined topic guides. Interviews were audio-recorded, transcribed, and subjected to thematic analysis. Overarching themes were defined by the study aims and the topic guides; subthemes were derived from the interview data. Results Sixty-six participants (three managers, eight glaucoma specialist consultant ophthalmologists, seven clinical glaucoma fellows, 12 optometrists (two of them performing SLT), two ophthalmic nurses and 34 patients) participated in the study. Overarching themes (and subthemes) were: necessity of non-medical SLT delivery, clinical practice and training, advantages, disadvantages, concerns, challenges, community delivery of SLT, patient values and other healthcare professionals that could also deliver SLT. Conclusions Certain clinical pre-requisites, such as gonioscopy and independent prescribing rights, were perceived as necessary for undertaking SLT training. An optometrist-delivered SLT service was expected to benefit the NHS, but there was an identified need of a standardised training scheme and robust governance. Patients were accepting of an optometrist-delivered SLT service in the hospital eye service.
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Jones L, Konstantakopoulou E, Gazzard G. Selective laser trabeculoplasty (SLT) performed by optometrists for patients with glaucoma and ocular hypertension: a scoping review. BMJ Open Ophthalmol 2021; 6:e000611. [PMID: 33782653 PMCID: PMC7957126 DOI: 10.1136/bmjophth-2020-000611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/16/2021] [Accepted: 02/06/2021] [Indexed: 11/04/2022] Open
Abstract
Selective laser trabeculoplasty (SLT) has been established as an effective treatment to lower intraocular pressure in people with glaucoma and ocular hypertension. The procedure is typically within the remit of ophthalmologists; however, there is potential to upskill optometrists and other healthcare professionals (HCPs) to deliver the treatment. We conducted a scoping review to identify the current global landscape of HCP-delivered SLT and describe training features, clinical effectiveness and safety. Relevant articles were identified through online database searches and grey literature sources. Four articles were selected for full inclusion. This review identified training programmes for optometrist-delivered SLT in the UK and the USA. The findings indicate that more research is needed to clarify training requirements and clinical effectiveness.
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Affiliation(s)
- Lee Jones
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Institute of Ophthalmology, University College London, London, UK
| | - Evgenia Konstantakopoulou
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Institute of Ophthalmology, University College London, London, UK.,Division of Optics and Optometry, University of West Attica, Attica, Greece
| | - Gus Gazzard
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Institute of Ophthalmology, University College London, London, UK
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Blakeney S. Optometrists are not allied health professionals. Ophthalmic Physiol Opt 2020; 40:700. [PMID: 32672846 DOI: 10.1111/opo.12716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/17/2020] [Indexed: 11/30/2022]
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