A study evaluating the integration of optometrists into primary care for managing neovascular age-related macular degeneration and glaucoma in Wales demonstrated significant benefits, including reduced waiting times and improved efficiency in hospital eye services. The research examined seven enhanced optometric service pathways and their impact on patient outcomes, healthcare efficiency, and cost-effectiveness.
Researchers used a mixed-methods approach to assess 3 neovascular age-related macular degeneration (nAMD) pathways and 4 glaucoma pathways within primary care settings. Methods included patient experience surveys, economic modeling, qualitative evaluations, and workforce assessments. The analysis focused on patient satisfaction, appointment accessibility, workforce readiness, and financial sustainability.
They found shifting nAMD and glaucoma care to optometrists in primary care settings significantly reduced wait times. Patients with suspected nAMD were seen within 4 to 5 days compared to 30 days in hospital eye services (HES). Glaucoma monitoring wait times dropped from nearly 2 years to just 5 days. Enhanced primary care services reduced waiting lists for nAMD from 216 to 3 patients and for glaucoma from 5691 to 5 patients. Further, surveys from 802 patients indicated that experiences in primary care settings were comparable to those in HES. Indeed, nAMD patients who received community-based care noted higher satisfaction scores.
The time consultants spent on nAMD care dropped from 57% to approximately 16%, while time allocated to glaucoma care decreased from 48% to approximately 23%. This shift allowed specialists to focus on complex cases and increased HES capacity, Barbara Ryan of the School of Optometry and Vision Sciences at Cardiff University, and colleagues noted in their Ophthalmic and Physiologic Optics article.
They identified key factors that influenced the success of these models:
- A referral coordinator was essential for managing appointments and ensuring efficient patient flow.
- Trust and collaboration between optometrists and ophthalmologists were crucial for integrating services effectively.
- Clear communication about treatment pathways and patient involvement improved engagement and adherence.
- A growing number of optometrists were completing higher-level training to support the expanded role.
The voices of patients were also prioritized in the review. The investigators “found that patients in both HES and primary care-based services value receiving the right service in the right place and at the right time. Patients perceived primary care-based clinics to be more accessible geographically and being able to negotiate appointment times was also important. Others have found that this can lead to greater engagement with eye care services.”
Trained optometrists who can manage nAMD and glaucoma in primary care could alleviate pressure on hospital services, improve patient access to care, and prevent vision loss due to delays. The findings align with policy shifts that favor decentralized eye care services and suggest integrating optometrists into primary care settings is a viable strategy for improving efficiency and patient outcomes. Specifically, a fee increase to £91 addressed the issue of lost revenue for optometrists when fees were £62.74. Increases in costs for practices with nAMD pathways were still lower than the traditional HES pathway, though they were “marginally more costly compared with the traditional HES pathway” for glaucoma.
Importantly, “all 3 health boards reported that no safety incidents had been reported relating to the enhanced optometry service pathways during the time of the study,” the researchers noted.
They also recognized limitations, including that the data were routinely collected service data, rather than clinical trial data. Response rates to the survey were also not able to be calculated, and further studies are needed to explore the long-term impact of these service models on clinical outcomes and healthcare system sustainability. Research should also examine implementation feasibility in other regions and the potential expansion of optometric-led care for additional eye diseases.
A full list of author disclosures can be found in the published research.