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NPSA sets deadline for glaucoma

National Patient Safety Agency sets deadline for Ophthalmology Departments and NHS Service Managers

In a Rapid Response Report today the NPSA highlights the results of a survey which show that between June 2005 and May 2009, 44 glaucoma patients experienced deterioration of vision and 13 loss of vision due to delayed follow up appointments.  91 other patients either suffered from delayed, cancelled or postponed appointments the consequences of these not being known.

Sinc the NICE ruling on suspected open angle glaucoma patients on 22nd April this year, which make recommendations on treatment and follow up procedures the NPSA has issued an immediate instruction to ophthalmology departments and service managers to

1. Make NICE guidelines on glaucoma available to all relevant staff and develop an action plan to implement the recommendations.

2. Review levels of hospital initiated cancellation of appointments for patients with established or suspected glaucoma through clinical governance forums.

3. Review patient ‘did not attend’ rates in order to identify and audit high risk non-attending patients.

4. Identify the number of patients currently awaiting follow up and confirm there is sufficient capacity within the local health community to meet this number in terms of outpatient appointments and any specialist investigations e.g. visual field and optic disc imaging.

5. Develop a system whereby patients can be ‘flagged’ on the booking/ appointment system to indicate the clinical priority given to the appointment and monitor activity to ensure compliance with NICE follow-up intervals.

6. Make information on glaucoma available to patients and ensure that there is a straight forward process for patients to reschedule appointments where necessary.

The Deadline for the action to be completed is 10th December 2009.

PHN Comment

These are very worthy ideals and it is surprising given the unstable nature of open angle (chronic) glaucoma that they are not already in place.  However at a time when the service has become unexpectedly loaded with additional high intra-ocular pressure patients with no obvious symptoms that were once regularly assessed by qualified and trained optometrists with local control by ophthalmologists directly. Because of the heavy handed approach by NICE on the issue one has to ask do NHS departments really know what is happening in the field. We endorse the actions taken by the NPSA and wonder that if these had been in place and the local enhanced services between secondary care and primary care in referral procedures had remained whether the solution was already in hand?


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