The necessary relationship between optometrists and ophthalmologists has always been a slightly reluctant one with the former often having to fight for recognition of their expertise and the latter being reluctant to acknowledge it. This somewhat prickly association flared up once more yesterday via industry media sites.
Michael Clarke, consultant ophthalmologist at Newcastle upon Tyne Hospitals NHS Foundation Trust claimed in a comment piece on the BMJ website yesterday that opticians are making too many referrals to ophthalmology departments and therefore contributing to the ever-increasing pressure put on hospital eye clinics around the country. He estimates that as many as 30% of referrals are false positives and these cases should not have been referred at all.
The head of policy at the Association of Optometrists (AOP), David Craig, of course had to respond to this and he did so via the AOP’s publication, Optometry Today. Craig’s response acknowledges the burden on NHS ophthalmology services and that optometrists are all too aware of this. The problem, he claims, lies with the fact that the NHS won’t reimburse optometrists to carry out further tests that would enable them to rule out dangerous eye conditions and therefore prevent unnecessary referrals.
This part is certainly true. Most optometrists for example now have Optical Coherence Tomography (OCT) technology that will give a 3D, high definition view of the retina, enabling them to detect sight-threatening conditions like macular degeneration. However the cost of using this expensive technology is not included in a standard NHS-funded eye test. So, if the optometrist even slightly suspects macular degeneration, he has to refer the patient, rather than using OCT to perform a more accurate check. Michael Clarke is however unconvinced that reimbursing more opticians to carry out this kind of testing will have any impact on the number of referrals to hospital eye clinics.
You cannot help but think as you read these two opposing articles that it’s time for everyone to put their reservations to one side and come up with a diagnostic pathway and reimbursement plan that is best for the patient. Surely, with the right kind of training and diagnostic tools, a way could be found to divert some of the burden away from hospital eye clinics, allowing optometrists to pre-screen for certain designated eye conditions?
My mother-in-law suffers from wet AMD and I know just how vital it is to get a diagnosis as early as possible to allow treatment to commence. It can literally mean the difference between losing your sight or keeping it. So it makes no sense to delay a diagnosis that could be made by an optometrist there and then, just because the NHS will only fund an ophthalmologist to use pretty much the same equipment at a hospital a few weeks later. Those few weeks could be all it takes for that patient to lose their sight forever.