Brighton Hove PCT

8/6/2019 Brighton Hove PCT

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Chronic Eye DiseaseChronic Eye DiseasePilot ProgrammePilot Programme

ARMDARMDBrighton & Hove PCTBrighton & Hove PCT

Gek OngGek OngProject ManagerProject ManagerBSUHBSUH


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What is ARMD?What is ARMD?

Most common cause of blindness inMost common cause of blindness in>65 yrs>65 yrs

Mild changes: drusenMild changes: drusen Severe changesSevere changes

dry AMDdry AMD

wet AMD: Classic/Occultwet AMD: Classic/Occult

No treatment for most patients untilNo treatment for most patients untilrecently: PDTrecently: PDT

Treatment needs to be deliveredTreatment needs to be delivered

quicklyquickly


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Project AimsProject Aims

Increase awareness of patients to check andIncrease awareness of patients to check andreport loss of vision in one eyereport loss of vision in one eye

Training for optometrists to maximise abilityTraining for optometrists to maximise abilityto diagnose ARMD accuratelyto diagnose ARMD accurately

Rapid access for patients to specialist clinicsRapid access for patients to specialist clinicsfor Fluorescein Angiography and treatmentfor Fluorescein Angiography and treatment

Assess role of telemedicine to improveAssess role of telemedicine to improvediagnostic accuracydiagnostic accuracy

Faster access to social service/ rehabilitationFaster access to social service/ rehabilitationsupportsupport


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Key Step 1Key Step 1

IMPROVING ACCESSIMPROVING ACCESS

by enhancing the role of communityby enhancing the role of communitybased optometristsbased optometrists


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ENHANCING HES SERVICESENHANCING HES SERVICES

to provide streamline access toto provide streamline access to

investigation/treatment/education clinicinvestigation/treatment/education clinicfor patients with ARMDfor patients with ARMD


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IMPROVING EFFICIENCYIMPROVING EFFICIENCY

create stronger links and communicationcreate stronger links and communicationwith local voluntary/support groups whowith local voluntary/support groups who

provide rehabilitation support andprovide rehabilitation support and

information for people with recent sightinformation for people with recent sightlossloss


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Current ARMD PathwayCurrent ARMD Pathway


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Patients with

visual problem

A&E

Clinic

Ophthalmologist

FFA Clinic

Retinal Clinic

Diagnosis

Starts treatment regime

Treat-

able?

YES

ECLO

Counselling/Support Group

Low Vision Services

Social Service Support

ROVI

NO

GPHigh Street

Optometrist

Problems with Current Services:

y Lack of collaboration between

healthcare and social serviceproviders

y Lack of timely diagnosis and ease

ofaccess to treatments/social

services for patients with ARMD

y

Too many inappropriate referrals;5:1 (Liverpool study, 2004)


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IMPROVING ACCESSIMPROVING ACCESS

by enhancing the role of communityby enhancing the role of communitybased optometristsbased optometrists


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Community OptometristsCommunity Optometrists

Establishing and maintaining essentialEstablishing and maintaining essentialskills: use of slit lampskills: use of slit lamp

Lecture to optometrists re diagnosis ofLecture to optometrists re diagnosis ofARMDARMD

Periodical attendance of ARMD clinicPeriodical attendance of ARMD clinic

Detailed protocol and guidelines forDetailed protocol and guidelines forreferring ARMD ptsreferring ARMD pts

Accredited optometrists to refer dry ARMDAccredited optometrists to refer dry ARMDdirect to social services etcdirect to social services etc


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But first..But first..How good are optometrists inHow good are optometrists in

detecting ARMD?detecting ARMD?


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Optometrists

Direct referral to HES

1-2 wks appt

Macular Clinic

Ophthalmologist

FFA

needed?

FFA Clinic

Ophthalmologist

Diagnosis

Treatment Date within a week

Treatable?

YES: CNV or Suspected CNV ARMD

YES

ECLO


Low Vision Services

Social Service SupportROVI

NO

NO: Non CNV ARMD

PDT Treatment

CNV or Suspected CNV

ARMDNon CNV ARMD

Education Services led by

nurses

Camera Digital Assessment

On Going Review


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ENHANCING HES SERVICESENHANCING HES SERVICES

to provide streamline access toto provide streamline access to

investigation/treatment/education clinicinvestigation/treatment/education clinicfor patients with ARMDfor patients with ARMD


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Patients with

visual problem

A&E

Clinic

Ophthalmologist

FFA Clinic

Retinal Clinic

Diagnosis

Starts treatment regime

Treat-able?

YES

ECLO


Low Vision Services


ROVI

NO

GPHigh Street

Optometrist

Too much unnecessary delays in

the present pathway!


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Diagnosis of treatable ARMDDiagnosis of treatable ARMD

Fluorescein AngiographyFluorescein Angiography


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Macular Clinic Ophthalmologist

FFA

needed?

FFA Clinic

Ophthalmologist

Diagnosis


Treatable?

YES

YES

ECLO

NO

NO


FFA

needed?

FFA Clinic

Ophthalmologist

Diagnosis


Treatable?

YES

YES

ECLO

NO

NO

HES ServicesHES ServicesOne-Stop


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IMPROVING EFFICIENCYIMPROVING EFFICIENCY

create stronger links and communicationcreate stronger links and communicationwith local voluntary/support groups whowith local voluntary/support groups who

provide rehabilitation support andprovide rehabilitation support and

information for people with sight lossinformation for people with sight loss


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SussexEyeHospitalSussexEyeHospital

ARMD Support GroupARMD Support Group Established since 1995Established since 1995

Led by a senior Ophthalmic Nurse withLed by a senior Ophthalmic Nurse with

Rehabilitation Officer (ROVI)Rehabilitation Officer (ROVI) Once a month; pt rings to book appt.Once a month; pt rings to book appt.

All ARMD pts attending HES clinic areAll ARMD pts attending HES clinic aregiven:given:

ARMD selfARMD self--help guide (SEH)help guide (SEH)

Support Group leafletSupport Group leaflet

ARMD guide with diet info & AmslerARMD guide with diet info & Amsler

chart (MDS)chart (MDS)


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Support Group Format 1Support Group Format 1

Describe ARMD & typesDescribe ARMD & types

Discuss investigations carried out eg. FFADiscuss investigations carried out eg. FFA

Discuss medical treatment available forDiscuss medical treatment available forWet ARMD eg. Argon laser & PDTWet ARMD eg. Argon laser & PDT

Alternative treatment on the market eg.Alternative treatment on the market eg.Ocuvite, IOcuvite, I--CapCap

Nutritional advice: dark green leafyNutritional advice: dark green leafyvegetables, carrotsvegetables, carrots

Check what problems the pts areCheck what problems the pts are

experiencing. Can ROVI help?experiencing. Can ROVI help?


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Support Group Format 2Support Group Format 2

Refer to the appropriate ROVI dependingRefer to the appropriate ROVI dependingon where the patient liveson where the patient lives

Refer to the LVA clinic if requiredRefer to the LVA clinic if required Record action in the pts notes.Record action in the pts notes.


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Presently ARMD pts are informed ofPresently ARMD pts are informed ofthis Support Group when attendingthis Support Group when attendingHES clinicHES clinic

Plan to provide info pack forPlan to provide info pack foroptometrists for their ARMD pts.optometrists for their ARMD pts.


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Social Services/Rehab SupportSocial Services/Rehab Support

Local centres for visually impairedLocal centres for visually impaired

RedRed--Cross;Cross;

RNIB;RNIB; Brighton Society for the BlindBrighton Society for the Blind

Facilities:Facilities:

social services; community low visionsocial services; community low visionclinics; training facilities such as kitchenclinics; training facilities such as kitchenset up with talking microwave, talkingset up with talking microwave, talkingscales; TV screen enlargers; softwarescales; TV screen enlargers; software

for enlarging computer screenfor enlarging computer screen


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Project MeasuresProject Measures

Traditional Pathway durationTraditional Pathway duration

Time from symptoms to optician, toTime from symptoms to optician, toGP, to clinic to accurate diagnosisGP, to clinic to accurate diagnosis

New Pathway durationNew Pathway duration

Proportion of patients referred attendProportion of patients referred attendthe appointments /and take upthe appointments /and take upopportunities around pathway supportopportunities around pathway supportservicesservices

Number of people presenting with multipleNumber of people presenting with multiple

eye conditionseye conditions


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Final ModelFinal Model


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Optometrists with digital

Camera

Direct referral to HES

1-2 wks appt


FFA

needed?

FFA Clinic

Ophthalmologist

Diagnosis


Treatable?

YES

YES

ECLO


Low Vision Services


ROVI

NO

NO

PDT Treatment

CNV or Suspected CNV ARMD

Non CNV ARMD

Education Services led by nurses

Telemedicine:

Printout/CD

Ophthalmologist

On Going Review


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Thank YouThank You

Brighton Hove PCT

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