We are delighted to have received some funding from the National Lottery. This contribution will help us work more efficiently in providing support to people within their local community. Thank you to the players for helping to prevent glaucoma sight loss.
The IGA is working with the Royal College of Ophthalmology, Macular Society and the RNIB to respond to this consultation.
Following the delay, we have now been informed that the consultation will the published at the end of July. Please check back for more information on its publication and how to respond.
National Tariff Consultation June 2018 – RCOphth, RNIB, IGA and Macular Society collaborate on response
13 June 2018
In preparation for the National Tariff Consultation due to be released 14 June 2018, The Royal College of Ophthalmologists and patient organisations; Royal National Institute for the Blind (RNIB), International Glaucoma Association (IGA) and the Macular Society, have collaborated on key messages that will be used in response to the consultation. This group have written to NHS Improvement to make them aware of:
- The crisis in the hospital eye service is not news, it is overwhelmed due to the needs of an ageing population and the increase in chronic eye disease requiring long term treatment and follow up care
- How the current national tariff system adversely affects follow up patients, who are the most vulnerable group with long-term chronic eye disease
The key messages from The Royal College of Ophthalmologists and our partner patient organisations are outlined below and we encourage patients and medical and healthcare professionals working in the hospital eye services to respond to the upcoming National Tariff Consultation. The Royal College of Ophthalmologists encourages our members to either respond to the consultation or provide comments and feedbackto Laura Coveney, Policy Researcher, email@example.com
National Tariff – Key messages
Eye care services are under severe/unprecedented pressure
There has been a 20%-30% increase in clinical activity over the last 10 years so that now there are 9 million patients per annum attending hospital eye services with ophthalmology accounting for 8% of all outpatient appointments. A 30-40% increase in outpatient activity is predicted over the next 20 years. Demographic changes and treatments for previously untreatable conditions, including for long term conditions, have increased demand for services. There are not enough medical training posts to match this increased need so there are many unfilled consultant and SAS posts.
Despite every effort to innovate and improve efficiency services cannot cope with the number of patients
Ophthalmology is making every effort to improve in efficiency and manpower eg:
- Converting activity from in-patient theatre to outpatients, overnight stays to day cases, and general anaesthetic surgery to local anaesthetic surgery, with more productive theatre lists
- Increased use of the multidisciplinary team with orthoptists, optometrists and nurses working in extended roles delivering “medical” tasks and use of technicians and virtual clinics in hospitals.
- Increased use of community optometrists for reducing unnecessary referrals and managing low risk cases in the community
But currently there is still great difficulty in seeing the number of patients who need care.
Ophthalmology is not all planned operations and minor disease and there are enormous numbers of patients with chronic sight threatening disease
There is an assumption that ophthalmology is mainly cataracts and other planned operations or minor conditions. However, a significant proportion of ophthalmic patients have chronic diseases such as glaucoma, macular degeneration and diabetic retinopathy. These diseases cause loss of sight and blindness and, once the vision is lost, it cannot be regained.
Loss of sight is devastating and costly
Loss of sight, especially if avoidable, is devastating, reduces quality of life and independence, affects employment and the ability to drive, increases the risk or impact of numerous other health issues including falls, depression and dementia. This has a huge health and social care, and societal, cost.
The highest risk of visual loss is in follow up patients not new patients
The highest risk of permanent visual loss in ophthalmology is not in new patients – patients requiring follow up are 8-9 times more likely to have a chronic sight threatening condition.
Lack of capacity is causing permanent harm in follow up patients due to delays
There is strong evidence of the lack of capacity causing delays, particularly to follow up patients, with the highest risk of avoidable visual loss from delayed care being in chronic diseases (glaucoma, retinal conditions). Data from national incidents and research studies (British Ophthalmic Surveillance Unit) and from patient groups show about 200 patients per year with avoidable permanent vision loss since 2010. Many, many patients are becoming distressed and anxious about their delays.
The system is biased towards protecting new patients which increases the risk for the follow up patients missing care
Currently, the system is skewed towards favouring new patient activity over follow up, through: concentration on RTT18 targets for new patients and a lack of similar target for follow ups; no national data systems to collect outpatient delay data; commissioners efforts to drive down new to follow up ratios; and the front loading of the new patient tariff by 30% versus the follow up tariff. This is creating perverse incentives to see new patients in preference to follow ups and sends the message to providers and commissioners that follow ups are less important, which is worsening the situation already present due to inadequate capacity.
The patient experience
Research undertaken by the International Glaucoma Association (IGA) in 2017 shows that over 40% of their members have been adversely affected by cancellations or delays to follow up, with 22% of those experiencing delays saying that they were advised at the clinic they eventually attended that they had suffered further loss of their field of vision. This is leaving patients distressed, anxious and scared about the impact on their sight and their lives of the delays to their care. Only the confident and persistent are able to navigate through a dysfunctional system. Some people, who are able to afford it, refer themselves to private health care thus creating a two tier health system which is unacceptable and against the founding principles of the NHS.
Eye patients are very clear about the value of sight and the impact on their mental health and well being through needless loss of sight. A patient who works with The Royal College of Ophthalmologists, who has a potentially blinding eye condition and lung and breast cancer, says, ‘I would rather die from cancer with my sight intact than survive cancer blind. What shocks me is that I have to fight for everything to do with my eyes including medication, research into my eye condition and follow up appointments in a timely fashion to avoid continued loss of sight. However, with cancer, I am overloaded with appointments, information, support including acupuncture and counselling, medication and treatments and phone calls from various specialists, as well as approaches by researchers. Why can’t some of this money and service be diverted into my eye care?’
The All-Party Parliamentary Group (APPG) on Eye Health and Visual Impairment report, See the light: Improving capacity in NHS eye care in England, published in June 2018, confirms the scale of the issue and the harmful effect of delays on patients. For instance, of the 557 eye patients surveyed, just over half had at least one appointment or treatment delayed, 20% had at least one appointment or treatment cancelled and 15% reported both. For the majority of these patients this caused them anxiety, stress and had a negative impact on their day to day life. The report specifically concludes that the current national tariff for ophthalmology currently seriously disadvantages patients with glaucoma, wet age-related macular degeneration (AMD) and diabetic retinopathy who require follow up appointments and are particularly at risk of avoidable sight loss and calls for this to be urgently reviewed (recommendation 6). It also makes many other important recommendations including mandated measurement of and targets for follow up timing adherence, a higher national priority for eye care, better overall funding and staffing, and support for local and regional strategic service redesign and transformation.
Many ophthalmology disorders like glaucoma and age-related macular degeneration are lifelong serious conditions and patients should be treated equitably and feel supported and cared for throughout life and not just at the point of diagnosis.
The Royal College of Ophthalmologists, the RNIB, IGA and the Macular Society are calling for:
- A reversal of the tariff front loading structure back to 10%
- Tariffs for non face to face and non consultant care
- Avoidance of block contracts
- The recommendations of the APPG report addressed at all relevant levels from the Department of Health to achieve adequately funded, staffed, organised and monitored services for ophthalmic conditions for current and future demand to protect patients
References and further reading
APPG report on eye health capacity & demand ‘See the Light’ https://www.rnib.org.uk/professionals/health-professionals/appg-eye-capacity
RNIB. Sight loss: A public health priority. (2013). at http://www.rnib.org.uk/services-we-offer-advice-professionals-health-professionals/public-health-professionals
IGA Eye Health Services Failing People with Glaucoma https://www.glaucoma-association.com/news/eye-health-services-failing-people-glaucoma/
Surveillance of sight loss due to delay in ophthalmic treatment or review: frequency, cause and outcome. Foot B, MacEwen CJ. Eye (2017) 31, 771–775 https://www.rcophth.ac.uk/2017/02/bosu-report-shows-patients-coming-to-harm-due-to-delays-in-treatment-and-follow-up-appointments/
NSPA patient safety alert: rapid response alert on glaucoma 2009
Davies A, Baldwin A, Hingorani M, Dwyer A, Flanagan D. A review of 145234 ophthalmic patient episodes lost to follow-up. Eye 2017; 31: 422–429.
Pezzullo L, Streatfield J, Simkiss P, Shickle D. The economic impact of sight loss and blindness in the UK adult population. RNIB and Deloitte Access Economics 2016
The International Glaucoma Association response to the
All Party Parliamentary Group on Eye Health and Visual Impairment Report
See the light: Improving capacity in NHS eye care in England
The International Glaucoma Association (IGA) welcomes the APPG Eye Health and Visual Impairment review. Patients with glaucoma have been badly let down by lack of financial investment, poor policy decisions and chaotic communication and administration systems.
The report highlights the need for the forthcoming NHS Tariff review to redress the financial imbalance between first and follow up appointments. Glaucoma is a lifelong condition and we want to see a system where people with glaucoma are fairly treated and feel supported and cared for throughout life and not just at the point of diagnosis.
Our research shows that over 40 per cent of members have been adversely affected by cancellations or delays to follow up. Members call us distressed, anxious and scared about the impact that the delay will have on their sight. Only the confident and persistent are able to navigate through a dysfunctional system.
We have had members who have paid for private healthcare in order to avoid delays. The creation of a two tier health system is unacceptable and against the founding principles of the NHS.
The report is clear and confident in the recommendations for financial investment, revised pricing structure, increased recruitment and the need for joined up electronic patient records. We look forward to the Government response.
The IGA is the charity for people with glaucoma. Established over 40 years ago, it raises awareness, promotes research related to early diagnosis and treatment, and provides support to patients and all those who care for them. In addition it also part funds the IGA Professor Ophthalmology for Glaucoma and Allied Studies, Professor David Garway-Heath, at UCL and Moorfields Eye Hospital, London. Other services include a helpline, patient information, patient support groups, events for professionals and patients, as well as providing grants for research funding. It is run by a board of trustees which represents ophthalmologists, optometrists, ophthalmic nurses and people with glaucoma.
To read the report, click here.
A new small grant is available, jointly funded by the International Glaucoma Association and Fight for Sight. For further details please see https://www.fightforsight.org.uk/apply-for-funding/funding-opportunities/small-grant-awards-schemes/
The impact of dry eye on people with glaucoma
The International Glaucoma Association is focusing on the impact of dry eye syndrome for people with glaucoma during IGA National Glaucoma Week - 4 to 10 June 2018. Dry eye can have a debilitating effect on a person’s quality of life yet is little understood.
Dry eye syndrome affects 50 to 60 per cent of people with glaucoma and one in three people over the age of 65. It is a disorder where the eyes don’t make enough tears, or the tears evaporate too quickly. This can make eyes feel dry, scratchy and irritated or watery, and feel heavy and tired by the end of the day. In severe cases people report pain, discomfort and depression, and its impact has been compared with that of angina, dialysis and disabling hip fractures.
Commenting on the campaign, Karen Osborn says: “Dry eye has an adverse impact on quality of life, with people saying that they cannot read, find the sunlight painful, feel unhappy and can’t even open their eyes long enough to do certain daily tasks.”
“We want to encourage anyone who has aggravating dry eye symptoms to seek the advice of their optometrist, pharmacist or GP and it is important that people with glaucoma raise any dry eye symptoms with their ophthalmologist as a change of glaucoma treatment to a preservative free eye drop often helps to reduce the symptoms of dry eye syndrome”.
Glaucoma affects around 700,000 people in the UK and the majority of people will initially be treated with medical eye drops. Managing both dry eye and glaucoma effectively is important, but challenging. Both conditions are long-term but manageable.
What are the most common symptoms of dry eye?
Heavy tired feeling of the eyes
Difficulty reading or working on the computer
Blurriness of vision
Excessive watering of the eyes
Discomfort when wearing contact lenses
Stinging or burning of the eyes
A sandy or gritty feeling in the eyes
Pain and redness of the eyes
Tips to help
Drink lots of water which helps tear production
Get enough sleep
Avoid alcohol and spicy foods
Avoid smoking and smoky areas
Wear glasses or sunglasses on windy days
Avoid air-conditioned environments and draughts
Consider using a humidifier
Blink more frequently when using a computer screen or reading
Look away from computer screens every 30 minutes
Our leaflet contains lots more information:
Act now to stop people losing sight due to delayed and cancelled hospital appointments
Make sure the Government prioritises eye care by asking your MP to attend a Parliamentary reception to learn how they can help to stop people losing sight.
You can write to your MP by using the template letter below or by taking RNIB’s simple online action that will send the letter to your MP for you visit http://bit.ly/EyeAPPGWeb
Alternatively contact by email, Facebook or Twitter.
1. Sending the message in an email
Email subject line: Act now to stop people losing sight
The NHS eye care system is currently failing patients, service provision is not keeping pace with demand, meaning that hospitals are delaying and cancelling appointments, resulting in people losing sight.
The All Party Parliamentary Group on Eye Health and Visual Impairment (APPG) held an inquiry in to this problem and on June 6 will release its findings at a report launch event.
Ask your MP to attend the event and help to stop people losing sight due to delayed and cancelled appointments. You can either use the template letter attached and send it to your MP or take RNIB’s simple online action which will send the letter to your MP for you. Visit http://bit.ly/EyeAPPGEm
Ask your MP to attend the @EyeHealthAPPG report launch and help stop people losing sight due to cancelled or delayed appointments http://bit.ly/EyeAPPGTw
Ask your MP to attend the All Party Parliamentary Group on Eye Health and Visual Impairment report launch and help stop people losing sight due to cancelled or delayed appointments in eye clinics across England http://bit.ly/EyeAPPGFb
4. Contacting by Letter
Re: Capacity crisis in NHS Eye Care: APPG report launch, 6 June
I am one of your constituents and a patient at XXXX using eye care services((insert name of hospital or delete if more appropriate). I am aware that the increase in demand for eye care services in recent years means patients are experiencing delays in accessing sight saving care and treatment. Research shows that as a result of these delays and hospital cancellations some patients are permanently losing sight, despite the availability of sight saving treatments.
The All Party Parliamentary Group for Eye Health and Visual Impairment has conducted an inquiry to identify solutions to the capacity crisis in England, to ensure that services meet demand. The inquiry report will be launched at a reception in Parliament on 6 June 2018 from 4pm to 6pmin the Churchill Room.
You will have received an invitation from the Royal National Institute of Blind People (RNIB)and the Optical Confederation; I hope that you are able to attend the reception to learn about the situation in your Sustainability and Transformation Partnership area, and about what you can do to tackle the crisis.Please RSVP to Jessica Ford at RNIB (Jessica.firstname.lastname@example.org 0207 391 2184)
I would very much appreciate hearing what action you will take after the event to promote implementation of the recommendations from the inquiry.
Don’t risk glaucoma - a sight-stealing condition - highlights the Association of Optometrists and IGA
“Misdiagnosed glaucoma almost cost me my sight” – Palmers Green resident, Sheryll Karpel, thanks optometrist who helped her after the condition went undetected for three years.
This National Glaucoma Week (4-10 June 2018), the Association of Optometrists (AOP) is highlighting the importance of regular eye health checks in detecting sight-threatening conditions such as glaucoma – warning that the signs often go unnoticed.
Sheryll Karpel, from Palmers Green, suffered what she thought were optical migraines only to discover that she had an eye condition which could have permanently damaged her eyesight. Now she is reminding others to have regular sight tests to help safeguard their vision and raise awareness of glaucoma.
Ms Karpel frequently visited her GP over a three-year period: “I was suffering terribly with these regular attacks. I would be in awful pain for hours and the only thing that helped was laying down. When I listed the symptoms to my doctor, like headaches and coloured halos, I was told that I had optical migraines but every treatment I tried didn’t work.” Ms Karpel’s attacks became more frequent, from every three months to every three days.
Following a massive glaucoma attack, it was discovered, at a hospital examination, that Ms Karpel had closed-angle glaucoma – a condition considered a medical emergency that can rapidly damage the optic nerve: “My intraocular pressure, the fluid pressure inside the front part of my eye, was up to 60mmHg which I was told, in many cases would have caused permanent damage and I could have lost my sight – that outcome would have been devastating.” Ms Karpel needed emergency laser treatment at Moorfield’s Eye Hospital to make holes in the iris to reduce her intra-ocular pressure.
After the diagnosis and surgery, Ms Karpel registered with a local north London optometrist at Harley Bain Opticians. Ms Karpel said: “Although the procedure was successful, I had post-op complications – inflammation and retinal oedema. The prescription in my eyes was now so different that it made my vision very blurred and I often felt sick and dizzy. These symptoms, on a daily basis, became unbearable which is why I decided to visit a local practice.”
To help alleviate these symptoms, AOP member and optometrist, Harley Bain prescribed temporary eyewear while Ms Karpel awaited surgery on her left eye. Describing the difference it made, Ms Karpel said: “I was completely taken aback by the time Mr Bain took to make sure that I came away with glasses that really helped me – he spent over an hour examining my eyes and asking lots of questions. After struggling for so long, it was a huge relief to have that level of care.”
Speaking about her condition, Mr Bain said: “It might not have felt like it, but Ms Karpel is actually very lucky to be making the recovery that she is. Glaucoma is a very serious eye condition – it’s one of the leading causes of severe sight impairment. Unlike open-angle, or chronic, glaucoma, where symptoms develop slowly over time, closed-angle glaucoma can occur very quickly and if left untreated causes severe and permanent damage to your vision.”
Karen Osborn, Chief Executive from the International Glaucoma Association (IGA) said: “Glaucoma is the name given to a number of eye conditions. People with angle closure glaucoma will know that there is something wrong with their eyes and seek help, unlike the more common form of glaucoma in the UK which is primary open-angle glaucoma. This type of glaucoma has no obvious early symptoms and is why we stress the need for regular eye health checks to take place throughout life. All too often we hear from people who are distressed to realise that the sight they have lost cannot be recovered, and that an eye health check could have detected glaucoma earlier”.
Ms Karpel added: “My experience demonstrates why it’s just so important to have regular sight tests. It’s easy to take your sight for granted but looking back, if I’d talked to an optometrist about my symptoms sooner, it may have been picked up earlier and the outcome would have been much better.”
National Glaucoma Week is taking place 4-10 June 2018. To raise awareness of the condition, the AOP is launching a new video, ideal for sharing on social media, to highlight key symptoms. For more information about glaucoma and treatment options, read the AOP’s patient leaflet and the IGA’s leaflets on closed angle glaucoma and open angle glaucoma.
Information on a range of conditions, and general tips for looking after eyes, is available at www.aop.org.uk/patients. The IGA is the charity for people with glaucoma and has a helpline 01233 648 170 and website www.glaucoma-association.com.
Images and the AOP’s glaucoma awareness video can be downloaded here.
The International Glaucoma Association (IGA) advises Muslim glaucoma patients not to stop taking eye drop medication during Ramadan (Tuesday 15 May to Thursday 14 June) as stopping drops even for a short period of time can cause permanent loss of vision.
Hospital reports and calls to the IGA helpline have indicated that some Muslims cease using their eye drops during Ramadan, believing that using the eye drops will break their fast. Even more worrying is that many of these patients then stop using the drops completely when they don’t perceive any change to their sight. This will not be apparent to the individual until significant sight loss has occurred.
Glaucoma is a group of eye conditions in which the optic nerve is damaged, usually by excessive pressure within the eye. If left untreated, glaucoma can lead to serious loss of vision, with up to 40 per cent of sight being permanently lost before the effects are noticed by the individual. Fortunately glaucoma is the most common cause of preventable blindness and for the majority of glaucoma patients, daily eye drops are a simple solution to control their condition and save their sight.
Subhash Suthar, IGA Development Manager, comments: “We want to reassure the Muslim community that drops can be taken before dawn and after sunset (known as Suhoor and Iftar), when food and drink can be consumed. We also suggest that patients close the tear duct when taking eye drops (known as punctual occlusion) as this means that fluid stays in the eye and does not drain into the throat and so cannot be tasted. This is achieved by putting finger pressure at the corner of the eye next to the nose (punctual occlusion) immediately after instilling drops. It is distressing when patients realise through a follow up appointment at their ophthalmologist or optometrist that their vision has been damaged through stopping drops. ”
The IGA is working with the Muslim Council of Britain (MCB) to raise awareness of this issue.
MCB’s Deputy Secretary General Dr Omer El-Hamdoon, has confirmed that all Islamic Schools Of Thought agree that taking eye drops does not invalidate the fast unless the eye drops reach the throat, which is unlikely. More so, Islam advocates that people take care of their bodies.
IGA Advice for eye drops during Ramadan:
- Do not stop eye drops during Ramadan- all Schools of Thought support this
- If you are still doubtful, use morning drops at Suhoor and evening drops at Iftar
- Try practicing punctal occlusion following instillation of drops
As National Glaucoma Awareness Week approaches (4-10 June) the IGA also advises anyone planning a summer holiday to make sure they take their eye drops with them, as some patients either forget to take their drops with them, or think it will be fine to stop taking them while away, which could lead to serious sight loss.
The IGA works with all professionals involved in glaucoma management to educate about the need for good eye drop use and compliance. It helps to set up local patient support groups within hospitals and has some simple tips and films available on our website.
For more information on the IGA call 01233 64 81 64 or log onto
For further information please contact Annabel Hillary, 07884 430862, email@example.com
or Mary-Jane Greenhalgh, 07866 722051, firstname.lastname@example.org
About the International Glaucoma Association (Charity Registered in England & Wales no. 274681, in Scotland no. SC041550)
- The International Glaucoma Association (IGA) is the charity for people with glaucoma, with the mission to raise awareness of glaucoma, promote research related to early diagnosis and treatment, and to provide support to patients and all those who care for them. For more information, please visit:
- Set up in 1974, it is the oldest patient based glaucoma association in the world and it is a Charity Registered in Scotland, Northern Ireland, England & Wales.
- As part of its support services, it operates the IGA Sightline (helpline) and provides free information on any aspect of glaucoma.
4. For more information about glaucoma, contact the International Glaucoma Association (IGA) Sightline on 01233 64 81 70 (Monday to Friday, 9.30am–5.00pm).
High level Education Strategic Review consultation responses show support for new education approach
The GOC has published some high level findings from its Education Strategic Review concepts and principles consultation.
The high level summary publication shows 97 per cent of respondents agreed with the development of new education standards for optometrists and dispensing opticians. 82 per cent agreed with embedding clinical experience progressively from the start of education programmes.
Stakeholders also showed support for the GOC further informing its education requirements with its Standards for Practice for Optometrists and Dispensing Opticians, with 84 per cent in favour of embedding professionalism into education and training programmes.
GOC Chief Executive and Registrar, Vicky McDermott said: “We are delighted to have received many supportive responses to the consultation that will enable us to work at pace to develop our detailed proposals to equip future professionals with the skills, knowledge and behaviours needed to practise safely and competently in a changing sector.
“We will make concerted progress in the coming months to transform these concepts into workable approaches for the future.”
The GOC’s Education Strategic Review concepts and principles consultation ran from December 2017 to March 2018, comprised 21 questions and sought feedback on 11 concepts and principles. A total of 36 responses were received to the consultation, 26 from organisations and 10 from individuals.
The GOC has also commissioned a full independent analysis of the consultation feedback and will publish this separately.
To read the high level findings summary please visit: https://www.optical.org/en/Education/education-strategic-review/supplementary-reading.cfm