Chronic Eye Disease Pilot Programme ARMD

Brighton & Hove PCT Gek Ong Project Manager BSUH

What is ARMD?


 

Most common cause of blindness in >65 yrs Mild changes: drusen Severe changes dry AMD wet AMD: Classic/Occult No treatment for most patients until recently: PDT Treatment needs to be delivered quickly

Project Aims


Increase awareness of patients to check and report loss of vision in one eye Training for optometrists to maximise ability to diagnose ARMD accurately Rapid access for patients to specialist clinics for Fluorescein Angiography and treatment Assess role of telemedicine to improve diagnostic accuracy Faster access to social service/ rehabilitation support

Key Step 1
IMPROVING ACCESS
by enhancing the role of community based optometrists

Key Step 2
ENHANCING HES SERVICES
to provide streamline access to investigation/treatment/education clinic for patients with ARMD

Key Step 3
IMPROVING EFFICIENCY
create stronger links and communication with local voluntary/support groups who provide rehabilitation support and information for people with recent sight loss

Current ARMD Pathway

Patients with visual problem High Street Optometrist

A&E

GP

Clinic Ophthalmologist

Problems with Current Services:

y Lack of collaboration between healthcare and social service providers y Lack of timely diagnosis and ease of access to treatments/social services for patients with ARMD
ECLO NO

FFA Clinic

Retinal Clinic Diagnosis

Treatable?

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

YES Starts treatment regime Counselling/Support Group Low Vision Services Social Service Support ROVI

Key Step 1
IMPROVING ACCESS
by enhancing the role of community based optometrists

Community Optometrists


Establishing and maintaining essential skills: use of slit lamp Lecture to optometrists re diagnosis of ARMD Periodical attendance of ARMD clinic Detailed protocol and guidelines for referring ARMD pts Accredited optometrists to refer dry ARMD direct to social services etc

 

But first..
How good are optometrists in detecting ARMD?

Optometrists

Camera Digital Assessment

CNV or Suspected CNV ARMD

Direct referral to HES 1-2 wks appt

Non CNV ARMD

Macular Clinic Ophthalmologist NO: Non CNV ARMD

FFA needed?

YES: CNV or Suspected CNV ARMD FFA Clinic Ophthalmologist Diagnosis NO

Treatable? YES Treatment Date within a week Education Services led by nurses PDT Treatment

ECLO

On Going Review

Counselling/Support Group Low Vision Services Social Service Support ROVI

Key Step 2
ENHANCING HES SERVICES
to provide streamline access to investigation/treatment/education clinic for patients with ARMD

Patients with visual problem High Street Optometrist

A&E

GP

Clinic Ophthalmologist

FFA Clinic

Too much unnecessary delays in the present pathway!

Retinal Clinic Diagnosis

Treatable? NO YES Starts treatment regime

ECLO

Counselling/Support Group Low Vision Services Social Service Support ROVI

Diagnosis of treatable ARMD

Fluorescein Angiography

HES Services
One-Stop
Macular Clinic Ophthalmologist

FFA needed? YES FFA Clinic Ophthalmologist Diagnosis

NO

ECLO

Treatable? YES Treatment Date within a week

NO

Key Step 3
IMPROVING EFFICIENCY
create stronger links and communication with local voluntary/support groups who provide rehabilitation support and information for people with sight loss

Sussex Eye Hospital ARMD Support Group

 

Established since 1995 Led by a senior Ophthalmic Nurse with Rehabilitation Officer (ROVI) Once a month; pt rings to book appt. All ARMD pts attending HES clinic are given: ARMD self-help guide (SEH) self Support Group leaflet ARMD guide with diet info & Amsler chart (MDS)

 

Support Group Format 1

  

Describe ARMD & types Discuss investigations carried out eg. FFA Discuss medical treatment available for Wet ARMD eg. Argon laser & PDT Alternative treatment on the market eg. Ocuvite, I-Cap INutritional advice: dark green leafy vegetables, carrots Check what problems the pts are experiencing. Can ROVI help?

Support Group Format 2



Refer to the appropriate ROVI depending on where the patient lives Refer to the LVA clinic if required Record action in the pts notes.

 

Presently ARMD pts are informed of this Support Group when attending HES clinic Plan to provide info pack for optometrists for their ARMD pts.

Social Services/Rehab Support



Local centres for visually impaired

Red-Cross; Red RNIB; Brighton Society for the Blind

Facilities:
social services; community low vision clinics; training facilities such as kitchen set up with talking microwave, talking scales; TV screen enlargers; software for enlarging computer screen

Project Measures


Traditional Pathway duration Time from symptoms to optician, to GP, to clinic to accurate diagnosis New Pathway duration Proportion of patients referred attend the appointments /and take up opportunities around pathway support services
Number of people presenting with multiple eye conditions

 

Final Model

Optometrists with digital Camera CNV or Suspected CNV ARMD Non CNV ARMD Direct referral to HES 1-2 wks appt Ophthalmologist Telemedicine: Printout/CD

Macular Clinic Ophthalmologist

FFA needed? YES FFA Clinic Ophthalmologist Diagnosis

NO

ECLO

Treatable? YES Treatment Date within a week

NO

Education Services led by nurses

Counselling/Support Group Low Vision Services Social Service Support ROVI On Going Review

PDT Treatment

Thank You