The AOP and FODO have issued advice urging optometrists in Scotland to refer all patients who have repeated IOPs over 21mmHg for formal diagnosis of OHT.

The recommendation is backed by Michael Jones QC, of Edinburgh-based law firm Simpson & Marwick, and follows a consultation on the relevance of the NICE glaucoma guideline to practitioners in Scotland.

In theory NICE’s glaucoma guidelines do not apply in Scotland or Northern Ireland. However, for practitioners to protect themselves in any civil action brought by a patient or from allegations which could lead to a GOC fitness to practise hearing, the AOP and FODO are calling for the guidance to be taken into account.

The two optical bodies agree that the NICE guidelines on glaucoma ‘represent the best available knowledge of the diagnosis and treatment of glaucoma and hypertension’, and that practitioners, wherever they are based in the UK, should take the guideline into account when considering referrals for patients with IOPs over 21mmHg.

The Scottish Government Health Department recommends an IOPs referral threshold of 30mmHg or over. However, this is widely believed by optometrists and ophthalmologists to be too high and puts the patient at risk of venous occlusion if pressures are consistently over 28mmHg.

Whilst optometrists throughout the UK are urged to refer all those with IOPs over 21mmHg, practitioners in Scotland should perform repeat measurements in line with Scottish GOS first. If a patient’s pressures are not repeatedly or consistently over 21mmHg then they do not need to be referred.

An AOP spokesperson said: “The gist of our legal advice is that professional practitioners must follow their own professional judgement and that judgement must be informed by clinical research, evidence and guidance. In other words, whatever any body might tell practitioners to do does not take precedence over a clinician’s own professional judgement. It is not an adequate defence to say, ‘I was just doing what I was told’. If an optometrist genuinely believes, and can justify that belief with factual evidence, that a particular course of action is right for a particular patient, then he or she should do that, and should be safe, legally.”

A spokesperson for Optometry Scotland said: “The NICE guidelines should represent the default position in the absence of any supporting diagnostic procedures as provided for under the GOS guidelines in Scotland.”

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simon cartright
November 5th, 2009
Why are the AOP/FODO not recommending that optometrists make the formal diagnosis of OHT - hence removing any requirement to refer?