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Updated NICE guidelines on glaucoma referral
The Joint Working Group on NICE Glaucoma Guideline has issued updated guidance on referral. These can be viewed on the AOP web site:
http://www.aop.org.uk/uploaded_files/joint_working_group_guidance_on_glaucomaand_oht_referral.pdf
The guidance confirms that patients with IOPs measured at greater than 21 mmHg with any tonometer, including NCT, should be referred, except for patients over the age of 65, for whom there is more specific advice in the guidance – specifically:
“Practitioners may consider not referring patients at low risk of significant visual field loss in their lifetime – a. Patients aged 80 years and over with measured IOPs <26mmHg with otherwise normal ocular examinations (normal discs, fields and van Herick).
b. Patients aged 65 and over with IOPs of <25mmHg and with otherwise normal ocular examinations (normal discs, fields and van Herick).
These groups do not qualify for treatment under current NICE guidance. Such patients may be advised that they should be reviewed by a community optometrist every 12 months.”
The guidance acknowledges tacitly that visual fields are not a requirement for referral. The sentence “Where practitioners have determined that it is clinically necessary to perform a visual field assessment as part of particular eye examination, a copy of the visual field assessment should also be provided“ allows that there may be situations where a practitioner does not think it clinically necessary to perform a visual field assessment.
The AOP has endorsed this guidance and hopes that all optometrists, all ophthalmologists and all PCTs/LHBs will take heed.
The new guidance also includes information on what is considered the proper procedures for using non-contact tonometry.