Post COVID glaucoma service redesign utilising electronic patient triage and community optometry clinics (Fife, Scotland 2020—2022)

Niharika Nalagatla; Shameela Parveen; Kelvin K.W. Cheng; Caroline Styles; Andrew Blaikie; Peter Wilson; Bhavani Karri; David J. Chinn; Roshini Sanders; Glaucoma Team; Lisa Wong; Alan Ramsay; Steven Halstead; Michelle Boulton; David Cummins; Colin Ferrier; Gavin Galloway; Elizabeth Embrey; Duncan Preston

doi:10.1186/s12886-025-03882-7

Post COVID glaucoma service redesign utilising electronic patient triage and community optometry clinics (Fife, Scotland 2020—2022)

Niharika Nalagatla^*, Shameela Parveen, Kelvin K.W. Cheng, Caroline Styles, Andrew Blaikie, Peter Wilson, Bhavani Karri, David J. Chinn, Roshini Sanders, Glaucoma Team, Lisa Wong, Alan Ramsay, Steven Halstead, Michelle Boulton, David Cummins, Colin Ferrier, Gavin Galloway, Elizabeth Embrey, Duncan Preston

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Background COVID-19 caused a huge backlog of patients in glaucoma clinics. This study describes redesign of an entire glaucoma service with electronic patient triage to three levels and utilisation of the Scottish optometry infrastructure of upskilled optometrists.
Methods 2276 patients in glaucoma clinics were identified and triaged to three levels in keeping with Glauc-strat-fast guidance with local amendments. Every patient detail was entered into a bespoke glaucoma database to include demographics, clinical findings and social deprivation scores. The database generated automatic patient, GP and optometrist letters. Level one patients (482) were discharged within the Scottish general optometry service contract. Level two patients (714) were discharged to glaucoma accredited community optometry clinics. The glaucoma consultants would discuss the optometry decision making through screen share once a week. Level three patients (1080) were retained in hospital. All outcomes were audited and analysed 24 months after the new service.
Results Statistically significant parameters were found between the three groups, to include more normal eyes, less mean deviation on visual fields and less social deprivation in level one patients. After 24 months level one patients had a return rate of 40.2%, mainly for other diseases with only 20.4% retained within hospital or level two. 9.4% of level two patients returned to hospital with retention of only 2.7% in hospital at 24 months.
Conclusion Glaucoma patients in Scotland can be appropriately triaged to glaucoma accredited community optometry clinics. This frees capacity within hospital to see patients with moderate and severe disease in a timely fashion, for best visual outcomes.

Original language	English
Article number	50
Pages (from-to)	1-7
Number of pages	7
Journal	BMC Ophthalmology
Volume	25
DOIs	https://doi.org/10.1186/s12886-025-03882-7
Publication status	Published - 29 Jan 2025

Keywords

Community optometry
Glaucoma
Risk stratification
Triage

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Nalagatla, N., Parveen, S., Cheng, K. K. W., Styles, C., Blaikie, A., Wilson, P., Karri, B., Chinn, D. J., Sanders, R., Glaucoma Team, Wong, L., Ramsay, A., Halstead, S., Boulton, M., Cummins, D., Ferrier, C., Galloway, G., Embrey, E., & Preston, D. (2025). Post COVID glaucoma service redesign utilising electronic patient triage and community optometry clinics (Fife, Scotland 2020—2022). BMC Ophthalmology, 25, 1-7. Article 50. https://doi.org/10.1186/s12886-025-03882-7

@article{60d7fb59ba054ddc9e80df8e99e8ccbe,

title = "Post COVID glaucoma service redesign utilising electronic patient triage and community optometry clinics (Fife, Scotland 2020—2022)",

abstract = "Background COVID-19 caused a huge backlog of patients in glaucoma clinics. This study describes redesign of an entire glaucoma service with electronic patient triage to three levels and utilisation of the Scottish optometry infrastructure of upskilled optometrists.Methods 2276 patients in glaucoma clinics were identified and triaged to three levels in keeping with Glauc-strat-fast guidance with local amendments. Every patient detail was entered into a bespoke glaucoma database to include demographics, clinical findings and social deprivation scores. The database generated automatic patient, GP and optometrist letters. Level one patients (482) were discharged within the Scottish general optometry service contract. Level two patients (714) were discharged to glaucoma accredited community optometry clinics. The glaucoma consultants would discuss the optometry decision making through screen share once a week. Level three patients (1080) were retained in hospital. All outcomes were audited and analysed 24 months after the new service.Results Statistically significant parameters were found between the three groups, to include more normal eyes, less mean deviation on visual fields and less social deprivation in level one patients. After 24 months level one patients had a return rate of 40.2%, mainly for other diseases with only 20.4% retained within hospital or level two. 9.4% of level two patients returned to hospital with retention of only 2.7% in hospital at 24 months. Conclusion Glaucoma patients in Scotland can be appropriately triaged to glaucoma accredited community optometry clinics. This frees capacity within hospital to see patients with moderate and severe disease in a timely fashion, for best visual outcomes.",

keywords = "Community optometry, Glaucoma, Risk stratification, Triage",

author = "Niharika Nalagatla and Shameela Parveen and Cheng, {Kelvin K.W.} and Caroline Styles and Andrew Blaikie and Peter Wilson and Bhavani Karri and Chinn, {David J.} and Roshini Sanders and {Glaucoma Team} and Lisa Wong and Alan Ramsay and Steven Halstead and Michelle Boulton and David Cummins and Colin Ferrier and Gavin Galloway and Elizabeth Embrey and Duncan Preston",

note = "Funding: Partial funding from the Scottish Government.",

year = "2025",

month = jan,

day = "29",

doi = "10.1186/s12886-025-03882-7",

language = "English",

volume = "25",

pages = "1--7",

journal = "BMC Ophthalmology",

issn = "1471-2415",

publisher = "BioMed Central",

}

Nalagatla, N, Parveen, S, Cheng, KKW, Styles, C, Blaikie, A, Wilson, P, Karri, B, Chinn, DJ, Sanders, R, Glaucoma Team, Wong, L, Ramsay, A, Halstead, S, Boulton, M, Cummins, D, Ferrier, C, Galloway, G, Embrey, E & Preston, D 2025, 'Post COVID glaucoma service redesign utilising electronic patient triage and community optometry clinics (Fife, Scotland 2020—2022)', BMC Ophthalmology, vol. 25, 50, pp. 1-7. https://doi.org/10.1186/s12886-025-03882-7

TY - JOUR

T1 - Post COVID glaucoma service redesign utilising electronic patient triage and community optometry clinics (Fife, Scotland 2020—2022)

AU - Nalagatla, Niharika

AU - Parveen, Shameela

AU - Cheng, Kelvin K.W.

AU - Styles, Caroline

AU - Blaikie, Andrew

AU - Wilson, Peter

AU - Karri, Bhavani

AU - Chinn, David J.

AU - Sanders, Roshini

AU - Glaucoma Team

AU - Wong, Lisa

AU - Ramsay, Alan

AU - Halstead, Steven

AU - Boulton, Michelle

AU - Cummins, David

AU - Ferrier, Colin

AU - Galloway, Gavin

AU - Embrey, Elizabeth

AU - Preston, Duncan

N1 - Funding: Partial funding from the Scottish Government.

PY - 2025/1/29

Y1 - 2025/1/29

N2 - Background COVID-19 caused a huge backlog of patients in glaucoma clinics. This study describes redesign of an entire glaucoma service with electronic patient triage to three levels and utilisation of the Scottish optometry infrastructure of upskilled optometrists.Methods 2276 patients in glaucoma clinics were identified and triaged to three levels in keeping with Glauc-strat-fast guidance with local amendments. Every patient detail was entered into a bespoke glaucoma database to include demographics, clinical findings and social deprivation scores. The database generated automatic patient, GP and optometrist letters. Level one patients (482) were discharged within the Scottish general optometry service contract. Level two patients (714) were discharged to glaucoma accredited community optometry clinics. The glaucoma consultants would discuss the optometry decision making through screen share once a week. Level three patients (1080) were retained in hospital. All outcomes were audited and analysed 24 months after the new service.Results Statistically significant parameters were found between the three groups, to include more normal eyes, less mean deviation on visual fields and less social deprivation in level one patients. After 24 months level one patients had a return rate of 40.2%, mainly for other diseases with only 20.4% retained within hospital or level two. 9.4% of level two patients returned to hospital with retention of only 2.7% in hospital at 24 months. Conclusion Glaucoma patients in Scotland can be appropriately triaged to glaucoma accredited community optometry clinics. This frees capacity within hospital to see patients with moderate and severe disease in a timely fashion, for best visual outcomes.

AB - Background COVID-19 caused a huge backlog of patients in glaucoma clinics. This study describes redesign of an entire glaucoma service with electronic patient triage to three levels and utilisation of the Scottish optometry infrastructure of upskilled optometrists.Methods 2276 patients in glaucoma clinics were identified and triaged to three levels in keeping with Glauc-strat-fast guidance with local amendments. Every patient detail was entered into a bespoke glaucoma database to include demographics, clinical findings and social deprivation scores. The database generated automatic patient, GP and optometrist letters. Level one patients (482) were discharged within the Scottish general optometry service contract. Level two patients (714) were discharged to glaucoma accredited community optometry clinics. The glaucoma consultants would discuss the optometry decision making through screen share once a week. Level three patients (1080) were retained in hospital. All outcomes were audited and analysed 24 months after the new service.Results Statistically significant parameters were found between the three groups, to include more normal eyes, less mean deviation on visual fields and less social deprivation in level one patients. After 24 months level one patients had a return rate of 40.2%, mainly for other diseases with only 20.4% retained within hospital or level two. 9.4% of level two patients returned to hospital with retention of only 2.7% in hospital at 24 months. Conclusion Glaucoma patients in Scotland can be appropriately triaged to glaucoma accredited community optometry clinics. This frees capacity within hospital to see patients with moderate and severe disease in a timely fashion, for best visual outcomes.

KW - Community optometry

KW - Glaucoma

KW - Risk stratification

KW - Triage

U2 - 10.1186/s12886-025-03882-7

DO - 10.1186/s12886-025-03882-7

M3 - Article

C2 - 39881229

AN - SCOPUS:85217357554

SN - 1471-2415

VL - 25

SP - 1

EP - 7

JO - BMC Ophthalmology

JF - BMC Ophthalmology

M1 - 50

ER -

Post COVID glaucoma service redesign utilising electronic patient triage and community optometry clinics (Fife, Scotland 2020—2022)

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Keywords

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