The group provides input from patients and the public to the College’s policies, guidance, and patient resources. For more details and an application form, please go to:
Invitation to an IGA Glaucoma Patient Conference, Newcastle 2018
Following the success of our Annual Lectures in London earlier in the year, we decided to hold a similar event for our members in the North East area, and I’m delighted to invite you to join us at a Patient Conference on Friday 30 November at The Great Hall, Sutherland Building, Northumbria University, Newcastle upon Tyne.
Refreshments will be available from 2pm and the event starts at 2.30pm with a keynote lecture about the future of glaucoma care by IGA Chair and consultant ophthalmologist Prof Philip Bloom, covering the latest news on laser and minimally invasive glaucoma surgery. This will be followed by a dry eye disease presentation by Glaucoma Clinical Fellow David Lunt, then optometrist Zoe Richmond will talk briefly about the role of optometrists in glaucoma care. This will be followed by a Q&A session where you can put questions to our panel of experts chaired by Prof Bloom, and we’ll end with a drinks reception from 5pm to 6.30pm.
The conference is free to attend but places are limited and booking is essential, so to secure your place and for details on how to find the venue and where to park, please call us on 01233 64 81 64 or email Richenda at firstname.lastname@example.org
Rural isolation and bad transport links were one of the reasons why Devon in Sight decided to take their services out into the community by creating Community Sight Loss Hubs.
They now have regular 'Talk and Support Groups' over a dozen locations across the county where clients have the opportunity to meet with others with sight loss, hear about the services available for them in their community and receive specialist training.
Their services continue as normal, with the majority being provided from their 13 Community Sight Loss Hubs. These hubs are operated by a community support team consisting of Cathy, Margaret, Rebecca and Tracey. Appointments are available to view lighting and daily living equipment at their new premises and at most of their Community Sight Loss Hubs.
How to contact:
Call the helpline on 01392 84 66 66
Please remember that Devon in Sight operates by APPOINTMENT ONLY
Devon in Sight, Splatford Barton, Kennford, Exeter EX6 7XY
Following the success of our Annual Lectures in London earlier in the year, we have decided to hold a similar event for our members in the North West, and we are delighted to announce that there will be a Patient Conference on Tuesday 16 October at the Holiday Inn Manchester City Centre, Aytoun Street M1 3AE.
The event starts at 2.30pm with a lecture from Mr Leon Au, Consultant Ophthalmic Surgeon at the Manchester Royal Eye Hospital (MREH), who will be speaking about new advances in glaucoma treatment. Following on, Cecilia Fenerty, Consultant Ophthalmic Surgeon at MREH will talk about the changing face of glaucoma care in the UK. The afternoon will finish with a Q&A panel where you will be able to put questions to Leon, Cecilia and other leading glaucoma experts. There will also be a drinks reception from 5pm to 6.30pm.
The patient conference is free to attend but places are limited and booking is essential, so to secure your place please call us on 01233 64 81 64 or email Richenda at email@example.com
Road safety charity Brake is teaming up with police forces in Thames Valley, Hampshire and West Midlands to run a month-long campaign on driver vision, revoking the licences of those who don't pass the 20m number plate check.
Throughout September, anyone stopped by Road Policing Officers in these areas will be required to take the 20m number plate test, with those who fail having their licence immediately revoked. Data will be collected from each test and will be used to gain an improved understanding of the extent of poor driver eyesight on our roads, which is thought to be vastly under-reported in Government statistics.
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We have just received the following announcement regarding the NHS tariff consultation
We are currently working with NHS England to develop our policies for the 2019 national tariff.
Following the funding settlement announced in July, it is essential that we align the development of our tariff and pricing proposals with the development of the wider long-term plan for the NHS. Engagement with the sector will take place in that context, and the publication of proposals will be aligned with the long-term plan and the planning guidance for 2019/20 and beyond.
Therefore, we will not be publishing a national tariff engagement document in the short term. We held a series of workshops to gather feedback on our developing policies in June and July. We will be undertaking further engagement on policies over the coming months.
Karen Osborn, Chief Executive “These are exciting results and there is no doubt that AI will play a role in the detection and monitoring of glaucoma. The use of technology to reduce the stress on hospital services and help optometrists with referral will ensure that people are correctly prioritised and appropriate treatment is commenced”.
ARTIFICIAL INTELLIGENCE AS GOOD AS TOP EXPERTS AT DETECTING EYE DISEASES
Ground-breaking research by Moorfields Eye Hospital, DeepMind Health and UCL uses artificial intelligence (AI) to help identify potentially blinding eye diseases.
- AI system can recommend the correct referral decision for over 50 eye diseases with 94% accuracy – matching world-leading eye experts.
- System could help doctors and other eye health professionals spot serious conditions earlier and prioritise patients who urgently need treatment.
- An artificial intelligence (AI) system that can recommend the correct referral decision for over 50 eye diseases as accurately as world-leading experts has been developed by researchers at Moorfields Eye Hospital NHS Foundation Trust, DeepMind Health and University College London (UCL) Institute of Ophthalmology.The breakthrough research, published online by Nature Medicine, describes how machine learning technology has been successfully trained on thousands of historic de-personalised eye scans to identify features of eye disease and recommend how patients should be referred for care. It is hoped that the technology could one day transform the way professionals carry out eye tests, allowing them to spot conditions earlier and prioritise patients with the most serious eye diseases before irreversible damage sets in.More than 285 million people worldwide live with some form of sight loss, including more than two million people in the UK. Eye diseases remain one of the biggest causes of sight loss, and many can be prevented with early detection and treatment.
- Dr Pearse Keane, consultant ophthalmologist at Moorfields Eye Hospital NHS Foundation Trust and NIHR Clinician Scientist at the UCL Institute of Ophthalmology said: “We set up DeepMind Health because we believe artificial intelligence can help solve some of society’s biggest health challenges, like avoidable sight loss, which affects millions of people across the globe. These incredibly exciting results take us one step closer to that goal and could, in time, transform the diagnosis, treatment and management of patients with sight threatening eye conditions, not just at Moorfields, but around the world. “We’re immensely proud of this work, which once again demonstrates what is possible when world-leading clinicians and technologists collaborate to improve patient care”.
- Matt Hancock, Health and Social Care Secretary, said: “This is hugely exciting and exactly the type of technology which will benefit the NHS in the long term and improve patient care - that’s why we fund over a billion pounds a year in health research as part of our long term plan for the NHS.”
- Robert Dufton, chief executive at Moorfields Eye Charity, said: “The NHS has always nurtured medical breakthroughs and now artificial intelligence, although still in its infancy, has real potential to radically transform the way medicine is practiced. This exciting research provides important evidence about how AI can support doctors to provide more rapid diagnosis and treatment, freeing up clinicians’ time for direct patient care.”
- Cathy Yelf, chief executive of the Macular Society, said: “As optometrists are often the first port of call for people with the symptoms of eye disease, we are very excited about the potential that AI has to assist them in helping patients. Further support in prioritising the referral of the patients with the greatest need is in the interests of both practitioners and patients, and we look forward to the results of clinical trials of this technology.”Michele Acton, Chief Executive at Fight for Sight, said: “This paper shows the power of utilizing artificial intelligence in ophthalmology. Innovative research such as this could help hospital eye services manage their clinics more effectively in the future.”
- Professor Andrew Lotery, Chair Scientific Committee, The Royal College of Ophthalmologists, said:
- “Artificial intelligence has the potential to help us address so many challenging health issues. We’re delighted that it is being used to help those patients most at need to receive timely access to ophthalmologists and appropriate treatments. This is a great step forward and we believe that the use of artificial intelligence will have an increasing role in addressing eye diseases in the future.”
- Martin Cordiner, Head of Research at the College of Optometrists said:
- “Macular disease is the biggest cause of sight loss in the UK, affecting 600,000 people. It is extremely debilitating and timely treatment for patients with wet AMD, such as Elaine, is vital. Pressure on eye clinics has resulted in delays for many patients, which has tragically led to unnecessary sight loss. We’re excited by this latest development and hope in time this technology will alleviate the pressure on clinics and mean patients will get the urgent treatment they need.”
- Tony Young, NHS England’s National Clinical Director for Innovation, said:
- “The need for treatment for eye diseases is forecast to grow, in part because people are living longer, far beyond our ability to meet the demand using current practice. Artificial intelligence is showing the potential to transform the speed at which diseases can be diagnosed and treatments suggested, making the best use of the limited time of clinicians. AI will also help our understanding of sight loss. Moorfields Eye Charity is proud to have funded equipment which underpins Dr Pearse Keane’s work as part of our programme of philanthropic support in pioneering researchers.”
- “The UK leads the world in ground-breaking research and artificial intelligence has the potential to revolutionise the way we spot eye disease, and could be genuinely transformative for the NHS in the future.
- Elaine Manna, 71, from north London and mother of three, went blind in her left eye from wet age-related macular degeneration (AMD). She is now being treated at Moorfields Eye Hospital to save the remaining sight in her right eye. She said:
- “I lost the sight in my left eye in the year 2000 after noticing a sudden blurring of my vision. A few weeks went by and I was starting to get really worried. A doctor then told me I had a bleed at the back of my eye that needed to be treated urgently but it proved too late to save my sight. AMD has had a major impact on my life. I love going to the theatre but I find it difficult to see people’s faces and I struggle to find my way around dimly lit rooms. I really hope that technology can help people like me in the future.”
- Professor Sir Peng Tee Khaw, director of the NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology said:
“The results of this pioneering research with DeepMind are very exciting and demonstrate the potential sight-saving impact AI could have for patients. I am in no doubt that AI has a vital role to play in the future of healthcare, particularly when it comes to training and helping medical professionals so that patients benefit from vital treatment earlier than might previously have been possible. This shows the transformative research than can be carried out in the UK combining world leading industry and NIHR/NHS hospital/university partnerships.”
- Mustafa Suleyman, Co-founder and Head of Applied AI at DeepMind Health, said:
- Moorfields owns this database as a non-commercial public asset, which is already forming the basis of nine separate medical research studies. In addition, Moorfields can also use DeepMind’s trained AI model for future non-commercial research efforts, which could help advance medical research even further.
- The work which has gone into this project will also help accelerate wider NHS research for many years to come. For example, DeepMind has invested significant resources to clean, curate and label Moorfields’ de-identified research dataset to create one of the most advanced eye research databases in the world.
- If clinical trials are successful in demonstrating that the technology can be used safely and effectively, Moorfields will be able to use an eventual, regulatory-approved product for free across all 30 of their UK hospitals and community clinics, for an initial period of five years.
- The next step is for the research to go through clinical trials to explore how this technology might improve patient care in practice, and regulatory approval before it can be used in hospitals and other clinical settings.
- Secondly, the AI system can be easily applied to different types of eye scanner, not just the specific model on which it was trained. This could significantly increase the number of people who benefit from this technology and future-proof it, so it can still be used even as OCT scanners are upgraded or replaced over time.
- The AI has been developed with two unique features which maximise its potential use in eye care. Firstly, the system can provide information that helps explain to eye care professionals how it arrives at its recommendations. This information includes visuals of the features of eye disease it has identified on the OCT scan and the level of confidence the system has in its recommendations, in the form of a percentage. This functionality is crucial in helping clinicians scrutinise the technology’s recommendations and check its accuracy before deciding the type of care and treatment a patient receives.
- To establish whether the AI system was making correct referrals, clinicians also viewed the same OCT scans and made their own referral decisions. The study concluded that AI was able to make the right referral recommendation more than 94% of the time, matching the performance of expert clinicians.
- Using two types of neural network – mathematical systems for identifying patterns in images or data – the AI system quickly learnt to identify ten features of eye disease from highly complex optical coherence tomography (OCT) scans. The system was then able to recommend a referral decision based on the most urgent conditions detected.
- The study, which was launched in 2016, brought together leading NHS eye health professionals and scientists from the National Institute for Health Research (NIHR) and UCL with some of the UK’s top technologists at DeepMind to investigate whether AI technology could help improve the care of patients with sight-threatening diseases, such as age-related macular degeneration and diabetic eye disease.
- “The AI technology we’re developing is designed to prioritise patients who need to be seen and treated urgently by a doctor or eye care professional. If we can diagnose and treat eye conditions early, it gives us the best chance of saving people’s sight. With further research it could lead to greater consistency and quality of care for patients with eye problems in the future.”
- “The number of eye scans we’re performing is growing at a pace much faster than human experts are able to interpret them. There is a risk that this may cause delays in the diagnosis and treatment of sight-threatening diseases, which can be devastating for patients.
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, firstname.lastname@example.org
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