Best practice library – ophthalmology

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Key overarching resources

The resources below are relevant across most or all of the areas and metrics listed on this page.

Click here to download the GIRFT
national report on ophthalmology >

Click here to download “Restarting and Redesigning of Cataract Pathways in response to the COVID 19 pandemic”>

Click here to login and view the
Model Hospital ophthalmology metrics >

Click here to view the available NICE guidelines for Eye conditions

Click here access the National Eye Care hub on NHS Futures >

For a full list of ophthalmology pathways, click here

Sentinel top decile metrics and gateway self-assessment

Metric / recommendation Performance measure (top decile or national standard) Peri-COVID top decile performance
First eye cataract surgery conversion rate – conversion from first outpatient attendance to cataract surgery 95% 85%
Risk stratification of patients on the waiting list by each provider using consistent scoring across the ICS 100% 100%
Standard flow theatre including complex surgery – 8 cases per 4 hour list 8  6
High flow theatre – 10+ cases per 4 hour list 10 8
% patients seen in hospital outpatient clinic (with no significant ocular comorbidity) within 6 weeks of surgery <5% <20%
Referral filtering pathways in place for newly referred community Glaucoma patients  100% 75%
Percentage of referrals seen using primary care repeated measures
Percentage of referrals seen using primary care enhanced case finding  
Percentage of referrals seen using Glaucoma referral refinement (including gonioscopy) 
Virtual diagnostic clinics run for follow-up glaucoma patients attending outpatient clinic >30%
Risk assessment completed of delayed Glaucoma follow-up patients attending outpatient clinic
OCT referral filtering pathways for diabetic M1 patients in place
Percentage of patients risk assessed for medical retina patients attending outpatient clinic with delayed follow up
Injection rate – average number of injections per session 16 12

Click here to download the ophthalmology gateway document

Cataract

Comments on cataracts in the GIRFT
national report on ophthalmology >

Restarting and Redesigning of Cataract Pathways in response to the COVID 19 pandemic guidance document >

Cataract Hubs and High Flow Cataract
Lists guidance document >

NHSE/I Low Complexity Daycase Cataract Surgery Pathway >

Predilation patient information leaflet >

Cataract Risk Stratification for Low Complexity High Throughput Hubs >

Cataract consent form >

Shared Decision-Making Aid for Cataract Surgery during COVID recovery period >

Post-operative cataract specification document >

Anaesthesia in cataract hubs >

Referral Management – conversion rate

Case study: Improving cataract referrals in Croydon >

Comments on referral management in the GIRFT national report on ophthalmology >

Metric: Cataract surgery conversion rate – conversion from first outpatient attendance to cataract surgery >

Referral Management – risk stratification

Comments of eligibity for surgery in the GIRFT national report on ophthalmology

Standardised cataract referral form

Metric: Patient risk stratification used to organise cataract surgery

Case Study: Pre-operative validation at Hinchingbrooke Hospital

Theatre flow – standard flow

Comments on optimising surgical flow in the GIRFT national report on ophthalmology

GIRFT national report recommendation to deliver routine cataract surgery

Metric: Average number of cataract surgery procedures per standard operating theatre session

Theatre flow – high flow

Comments on high volume lists in the GIRFT national report on ophthalmology

Metric: Average number of high volume, low complexity cataract surgery procedures per standard operating theatre session

Case study: Risk stratification for high-volume lists at Derby and Delivery high-volume lists at Norfolk and Norwich

Post-operative

Comments on use of commissioned primary care optometry services and

Post-operative cataract patient information leaflet

Metric: Number of elective spells and outpatient attendances for patients of all ages where procedures for simple cataract surgery were delivered

Case study: Post-operative validation at Hinchingbrooke Hospital  

Case study: Using primary care optometrists for post-operative review following cataract surgery at CUH  

Glaucoma

National Eye Care Recovery and Transformation Programme – Glaucoma webinar, 28th September 2021

Referral Management

GIRFT national report recommendation on instituting consistent referral criteria in line with 2017 NICE guideline and referral filtering schemes

GIRFT national report recommendation to adopt model Glaucoma pathways

GIRFT national report recommendation to implement actions of high impact intervention 

Case Study: Manchester Glaucoma Enhanced Referral Scheme (GERS)

Metric: Community hospital delivery setting used for referral filtering for newly referred glaucoma patients

Metric: Referral filtering pathways for newly referred glaucoma patients attending outpatient clinic

Metric: Acute hospital delivery setting used for referral filtering for newly referred glaucoma patients

Clinic Flow

GIRFT national report recommendation for providers to introduce virtual clinics for Glaucoma

The elective care transformation programme handbook for ophthalmology includes best practice guidance for the use of virtual clinics 

Case study: Virtual clinics for managing low-risk glaucoma patients in Leeds

Metric: Virtual clinics run for follow-up glaucoma patients attending outpatient clinic

Clinic Risk

Comment on ensuring adequate follow-up in the GIRFT national report on ophthalmology

Case study: Consultant-led OCT at University Hospitals Birmingham

Metric: Estimated number of delayed glaucoma follow-up patients attending outpatient clinic 

Metric: Risk stratification of newly referred glaucoma patients attending outpatient clinic

Medical Retina (AMD)

Referral Management

GIRFT national report recommendation to develop a national standardised referral pathway for suspected diabetic maculopathy

Metric: OCT referral filtering pathways for diabetic M1 patients

Clinic Flow

Metric: AMD Injection rate -average number of injections per session for AMD

Case study: Community eye clinics in Manchester

Clinic Risk

GIRFT national report recommendation to increase the capacity and productivity of wet AMD pathways

Metric: Estimated number of medical retina patients attending outpatient clinic with delayed follow up

Miscellaneous Documents

Example Band 3 Failsafe officer job description and person spec >

Example Band 5 Failsafe officer job description and person spec >