Post on 07-Apr-2018
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Chronic Eye DiseaseChronic Eye DiseasePilot ProgrammePilot Programme
ARMDARMDBrighton & Hove PCTBrighton & Hove PCT
Gek OngGek OngProject ManagerProject ManagerBSUHBSUH
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What is ARMD?What is ARMD?
Most common cause of blindness inMost common cause of blindness in>65 yrs>65 yrs
Mild changes: drusenMild changes: drusen Severe changesSevere changes
dry AMDdry AMD
wet AMD: Classic/Occultwet AMD: Classic/Occult
No treatment for most patients untilNo treatment for most patients untilrecently: PDTrecently: PDT
Treatment needs to be deliveredTreatment needs to be delivered
quicklyquickly
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Project AimsProject Aims
Increase awareness of patients to check andIncrease awareness of patients to check andreport loss of vision in one eyereport loss of vision in one eye
Training for optometrists to maximise abilityTraining for optometrists to maximise abilityto diagnose ARMD accuratelyto diagnose ARMD accurately
Rapid access for patients to specialist clinicsRapid access for patients to specialist clinicsfor Fluorescein Angiography and treatmentfor Fluorescein Angiography and treatment
Assess role of telemedicine to improveAssess role of telemedicine to improvediagnostic accuracydiagnostic accuracy
Faster access to social service/ rehabilitationFaster access to social service/ rehabilitationsupportsupport
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Key Step 1Key Step 1
IMPROVING ACCESSIMPROVING ACCESS
by enhancing the role of communityby enhancing the role of communitybased optometristsbased optometrists
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Key Step 2Key Step 2
ENHANCING HES SERVICESENHANCING HES SERVICES
to provide streamline access toto provide streamline access to
investigation/treatment/education clinicinvestigation/treatment/education clinicfor patients with ARMDfor patients with ARMD
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Key Step 3Key Step 3
IMPROVING EFFICIENCYIMPROVING EFFICIENCY
create stronger links and communicationcreate stronger links and communicationwith local voluntary/support groups whowith local voluntary/support groups who
provide rehabilitation support andprovide rehabilitation support and
information for people with recent sightinformation for people with recent sightlossloss
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Current ARMD PathwayCurrent ARMD Pathway
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Patients with
visual problem
A&E
Clinic
Ophthalmologist
FFA Clinic
Retinal Clinic
Diagnosis
Starts treatment regime
Treat-
able?
YES
ECLO
Counselling/Support Group
Low Vision Services
Social Service Support
ROVI
NO
GPHigh Street
Optometrist
Problems with Current Services:
y Lack of collaboration between
healthcare and social serviceproviders
y Lack of timely diagnosis and ease
ofaccess to treatments/social
services for patients with ARMD
y
Too many inappropriate referrals;5:1 (Liverpool study, 2004)
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Key Step 1Key Step 1
IMPROVING ACCESSIMPROVING ACCESS
by enhancing the role of communityby enhancing the role of communitybased optometristsbased optometrists
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Community OptometristsCommunity Optometrists
Establishing and maintaining essentialEstablishing and maintaining essentialskills: use of slit lampskills: use of slit lamp
Lecture to optometrists re diagnosis ofLecture to optometrists re diagnosis ofARMDARMD
Periodical attendance of ARMD clinicPeriodical attendance of ARMD clinic
Detailed protocol and guidelines forDetailed protocol and guidelines forreferring ARMD ptsreferring ARMD pts
Accredited optometrists to refer dry ARMDAccredited optometrists to refer dry ARMDdirect to social services etcdirect to social services etc
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But first..But first..How good are optometrists inHow good are optometrists in
detecting ARMD?detecting ARMD?
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Optometrists
Direct referral to HES
1-2 wks appt
Macular Clinic
Ophthalmologist
FFA
needed?
FFA Clinic
Ophthalmologist
Diagnosis
Treatment Date within a week
Treatable?
YES: CNV or Suspected CNV ARMD
YES
ECLO
Counselling/Support Group
Low Vision Services
Social Service SupportROVI
NO
NO: Non CNV ARMD
PDT Treatment
CNV or Suspected CNV
ARMDNon CNV ARMD
Education Services led by
nurses
Camera Digital Assessment
On Going Review
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Key Step 2Key Step 2
ENHANCING HES SERVICESENHANCING HES SERVICES
to provide streamline access toto provide streamline access to
investigation/treatment/education clinicinvestigation/treatment/education clinicfor patients with ARMDfor patients with ARMD
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Patients with
visual problem
A&E
Clinic
Ophthalmologist
FFA Clinic
Retinal Clinic
Diagnosis
Starts treatment regime
Treat-able?
YES
ECLO
Counselling/Support Group
Low Vision Services
Social Service Support
ROVI
NO
GPHigh Street
Optometrist
Too much unnecessary delays in
the present pathway!
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Diagnosis of treatable ARMDDiagnosis of treatable ARMD
Fluorescein AngiographyFluorescein Angiography
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Macular Clinic Ophthalmologist
FFA
needed?
FFA Clinic
Ophthalmologist
Diagnosis
Treatment Date within a week
Treatable?
YES
YES
ECLO
NO
NO
Macular Clinic Ophthalmologist
FFA
needed?
FFA Clinic
Ophthalmologist
Diagnosis
Treatment Date within a week
Treatable?
YES
YES
ECLO
NO
NO
HES ServicesHES ServicesOne-Stop
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Key Step 3Key Step 3
IMPROVING EFFICIENCYIMPROVING EFFICIENCY
create stronger links and communicationcreate stronger links and communicationwith local voluntary/support groups whowith local voluntary/support groups who
provide rehabilitation support andprovide rehabilitation support and
information for people with sight lossinformation for people with sight loss
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SussexEyeHospitalSussexEyeHospital
ARMD Support GroupARMD Support Group Established since 1995Established since 1995
Led by a senior Ophthalmic Nurse withLed by a senior Ophthalmic Nurse with
Rehabilitation Officer (ROVI)Rehabilitation Officer (ROVI) Once a month; pt rings to book appt.Once a month; pt rings to book appt.
All ARMD pts attending HES clinic areAll ARMD pts attending HES clinic aregiven:given:
ARMD selfARMD self--help guide (SEH)help guide (SEH)
Support Group leafletSupport Group leaflet
ARMD guide with diet info & AmslerARMD guide with diet info & Amsler
chart (MDS)chart (MDS)
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Support Group Format 1Support Group Format 1
Describe ARMD & typesDescribe ARMD & types
Discuss investigations carried out eg. FFADiscuss investigations carried out eg. FFA
Discuss medical treatment available forDiscuss medical treatment available forWet ARMD eg. Argon laser & PDTWet ARMD eg. Argon laser & PDT
Alternative treatment on the market eg.Alternative treatment on the market eg.Ocuvite, IOcuvite, I--CapCap
Nutritional advice: dark green leafyNutritional advice: dark green leafyvegetables, carrotsvegetables, carrots
Check what problems the pts areCheck what problems the pts are
experiencing. Can ROVI help?experiencing. Can ROVI help?
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Support Group Format 2Support Group Format 2
Refer to the appropriate ROVI dependingRefer to the appropriate ROVI dependingon where the patient liveson where the patient lives
Refer to the LVA clinic if requiredRefer to the LVA clinic if required Record action in the pts notes.Record action in the pts notes.
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Presently ARMD pts are informed ofPresently ARMD pts are informed ofthis Support Group when attendingthis Support Group when attendingHES clinicHES clinic
Plan to provide info pack forPlan to provide info pack foroptometrists for their ARMD pts.optometrists for their ARMD pts.
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Social Services/Rehab SupportSocial Services/Rehab Support
Local centres for visually impairedLocal centres for visually impaired
RedRed--Cross;Cross;
RNIB;RNIB; Brighton Society for the BlindBrighton Society for the Blind
Facilities:Facilities:
social services; community low visionsocial services; community low visionclinics; training facilities such as kitchenclinics; training facilities such as kitchenset up with talking microwave, talkingset up with talking microwave, talkingscales; TV screen enlargers; softwarescales; TV screen enlargers; software
for enlarging computer screenfor enlarging computer screen
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Project MeasuresProject Measures
Traditional Pathway durationTraditional Pathway duration
Time from symptoms to optician, toTime from symptoms to optician, toGP, to clinic to accurate diagnosisGP, to clinic to accurate diagnosis
New Pathway durationNew Pathway duration
Proportion of patients referred attendProportion of patients referred attendthe appointments /and take upthe appointments /and take upopportunities around pathway supportopportunities around pathway supportservicesservices
Number of people presenting with multipleNumber of people presenting with multiple
eye conditionseye conditions
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Final ModelFinal Model
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Optometrists with digital
Camera
Direct referral to HES
1-2 wks appt
Macular Clinic Ophthalmologist
FFA
needed?
FFA Clinic
Ophthalmologist
Diagnosis
Treatment Date within a week
Treatable?
YES
YES
ECLO
Counselling/Support Group
Low Vision Services
Social Service Support
ROVI
NO
NO
PDT Treatment
CNV or Suspected CNV ARMD
Non CNV ARMD
Education Services led by nurses
Telemedicine:
Printout/CD
Ophthalmologist
On Going Review
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Thank YouThank You