Professional Documents
Culture Documents
Brighton Hove PCT
Brighton Hove PCT
Brighton Hove PCT
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
A&E
GP
Clinic Ophthalmologist
FFA Clinic
Treatable?
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
FFA needed?
Treatable? YES Treatment Date within a week Education Services led by nurses PDT Treatment
ECLO
On Going Review
Key Step 2
ENHANCING HES SERVICES
to provide streamline access to investigation/treatment/education clinic for patients with ARMD
A&E
GP
Clinic Ophthalmologist
FFA Clinic
ECLO
HES Services
One-Stop
Macular Clinic Ophthalmologist
NO
ECLO
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
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)
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?
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.
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
NO
ECLO
NO
Counselling/Support Group Low Vision Services Social Service Support ROVI On Going Review
PDT Treatment
Thank You