New GIRFT guidance aims to reduce the risk of avoidable sight loss through a clinical framework for the delivery of glaucoma care in England which prioritises early detection, accurate referrals and lifelong continuity of care.
Glaucoma remains one of the leading causes of irreversible sight loss. By 2060, the number of individuals living with glaucoma is projected to rise to 1.61 million. When detection is late, or follow-up and ongoing care is delayed, the consequences for patients can be profound and permanent.
If implemented across England, the GIRFT guidance could enable hundreds of thousands of patients with glaucoma to receive their follow-up care on time — helping to prevent avoidable sight loss.
The guidance supports the standardisation of local delivery pathways to ensure the risk of irreversible sight loss is minimised for glaucoma patients. It points to three key areas that will help co-ordinate care and reduce delays in follow-up appointments:
- Better filtering of patients with additional tests in the community to ensure more accurate referrals to a hospital glaucoma service – currently around 50% of referrals from optometrists have no evidence of glaucoma, due to it being a complex condition which is hard to accurately diagnose without repeat and enhanced clinical tests.
- Review patients more efficiently through high-volume virtual pathways with diagnostics and review being conducted in hospital and in the community, as well as in primary care settings.
- More efficient discharge for patients who no longer need follow-up appointments.
These steps will help to cut waiting times for appointments and help prevent avoidable sight loss due to delays in eye care follow-up.
Professor Tim Briggs, GIRFT programme lead and NHS England National Director for Clinical Improvement, Elective Recovery and UEC, said:
"Glaucoma remains one of the leading causes of irreversible sight loss, so the clinical imperative is clear: we must do everything we can to reduce the risk of avoidable blindness by delivering timely, consistent, high quality care whether patients are seen in the community, in hospital, or across both. If the new ways of working in this best practice guidance are implemented nationally, hundreds of thousands of patients could benefit from receiving their glaucoma follow‑up on time, helping to clear the backlog while ensuring patients receive the best care possible from high-performing services everywhere."
The guidance also focuses on continuity of care. This is important for a longitudinal disease like glaucoma, particularly where multiple providers may be involved in a patient’s care. To support this, and in line with the 10 Year Health Plan, the guidance highlights the importance of digitally enabled pathways and provision of care closer to home.
For new patients, this will involve additional testing in the community before they are referred to hospital: to help ensure they need the referral. Referral filtering can significantly reduce ‘false positive’ referrals, maintaining hospital glaucoma service capacity for higher risk new patients and higher risk follow-up patients.
For patients needing glaucoma follow up, conducting diagnostics and review in the hospital and the community, as well as in primary care settings, will help deliver more services on time. While for patients who no longer need follow up, they will be more likely to be discharged.
The guidance is supported by the Royal College of Ophthalmologists, the College of Optometrists, the Royal National Institute of Blind People, Glaucoma UK, the UK Ophthalmology Alliance, and the Independent Healthcare Providers Network.
Joanne Creighton, chief executive at Glaucoma UK said:
“The publication of the GIRFT guidance is an important step for glaucoma care at a time when services are under real pressure. Improving early detection, strengthening referral pathways and making better use of digital systems all have the potential to create a more joined-up and less stressful experience for patients.”
Daniel Hardiman-McCartney, clinical advisor at The College of Optometrists, said:
“We were pleased to contribute to the new GIRFT guidance for glaucoma care. The guidance has a clear emphasis on the vital role of primary care optometry in identifying and managing patients closer to home, helping prevent avoidable sight loss.”
Join our webinars
GIRFT is hosting a webinar on Tuesday 30 June (12pm – 1pm) to highlight the details of this new guidance, where we will be joined by panellists discussing the three key areas to help co-ordinate care and reduce delays in follow-up appointments, and how clinicians and organisations can work collaboratively for the benefit of patients. Register here
Follow-up webinars will be held specifically for commissioners (Tuesday 28 July: register here) and acute providers (Monday 24 August: register here).
The Department of Health and Social Care (DHSC) introduced the GIRFT guidance alongside announcing £20m investment in digitising referrals from the high street.
The investment will give every optical practice with an NHS contract in England access to the NHS e-Referral service and the National Care Record Service, with the aim of achieving 100% access by April 2028.
Community-based optometrists will be able to refer patients directly and digitally into NHS hospital eye services – including NHS Online when it launches next year – with access to relevant patient records to support faster and more accurate clinical decisions. This will reduce unnecessary referrals and mean fewer people need a separate appointment simply to be passed on to a specialist.
