Clinical Guidance

In this section:

  • AMD Advice
  • NICE Guidelines on Glaucoma
  • Cataract Referrals
  • College of Optometrists Clinical Management Guidelines 
  • Low Vision
  • Hospital Eye Clinic Support
  • GOC Rules relating to injury or disease of the eye

AMD Advice

Age related Macular Degeneration (AMD) is now the most significant cause of sight loss in the UK. Although wet AMD accounts for only 10 per cent of patients with AMD, 90 per cent of patients with significant vision loss have this form of the disease.  Estimates suggest that on average each optometrist should expect to identify 2.5 new cases of wet AMD each year.  The guidance below is directed to Optometrists.

NICE Guidelines on Glaucoma

The advice in the NICE guideline covers the diagnosis, treatment and care of:

  • adults (18 years and over) with a diagnosis of the condition known as 'chronic open angle glaucoma'
  • adults with a diagnosis of ocular hypertension (raised eye pressure)
  • adults who are at a high risk of developing glaucoma.

Click here to access the guidelines.

Referral Letters

In April 2009 NICE issued guidance to the NHS about conditions called Ocular Hypertension (OHT) and (suspected) Open Angle Glaucoma. This guidance requires special tests to be performed on any patient where the pressure in the eye is above a certain level as there is a small risk of developing glaucoma.

The links below provide access to model letters for patients and GPs.

Referral Refinement Pathway

The aim of a glaucoma referral refinement pathway is to reduce unnecessary referrals to the hospital eye service, reducing patient anxiety and increasing capacity within the overburdened hospital glaucoma clinics. This will provide a more cost effective service with a greater number of patients managed within the primary care setting. The document below provides further details.

The Optical Confederation has issued the following advice to accompany the LOCSU pathway; 
glaucoma referral refinement pathway.

Cataract Referrals

The following Optical Confederation guidance discusses the professional duty of business and individual registrants, referrals and good practice. Adherence to this advice should ensure that 

  • the maximum number of patients benefit according to clinical need and priority 
  • clinicians are practising safely within clinical guidelines, their professional codes of conduct and the legal requirements of their NHS contracts.

College of Optometrists 

The College of Optometrists' Clinical Management Guidelines provide a source of evidence-based information on the diagnosis and management of 56 eye conditions that present varying frequency in primary and first-contact care. 

Low Vision

  • On 1 September 2005, the registration form for patients with visual impairment changed. Instead of the BD8, a CVI (Certificate of Visual Impairment) should be used.
  • Social Services will only accept a CVI signed by a consultant ophthalmologist as evidence for registration. The terms ‘partial sight’ and ‘blindness’ have also been replaced by the terms ‘visual impairment’ and ‘severe visual impairment’ respectively. In addition to the CVI, two other new documents have been produced by the DH to assist patients with visual impairment.
  • Form RVI (Referral of Visual Impairment) is for use by hospital eye service staff and optometrists to alert social services (with the patient’s consent) that a patient has visual impairment and would benefit from an assessment.
  • A new low vision leaflet (LVL) has been designed for optometrists to hand out to patients with visual impairment to enable the patient to complete an accompanying form to self-request an assessment by social services.
  • Social Service Departments should be tailoring the LVL to include information about local self help groups and useful contacts and supplying the modified leaflets to optometrists in their area.

Further information and forms can be downloaded from the Department of Health website here.

Hospital Eye Clinic Support

The link below lists hospitals in the UK with eye clinic support.

GOC Rules relating to injury or disease of the eye