Ophthalmology – Raised IOP Referrals (Adults only) Patient attends Optometrist for sight test Patient has raised IOP and/or abnormal visual fields and/or abnormal optic discs Referral sent to the GP by Optometrist using GOS 18 form which GPs then scan onto Practices Clinical System GP assesses whether patient meets criteria in commissioning policy Pressure reading below 21mmHg, visual fields normal and optics discs normal Patient does not meet criteria stated in commissioning policy. Either manage conservatively in the community or consider Individual Funding Request Pressure reading between 21mmHg & 25mmHg, visual fields normal and optics discs normal Acute Angle Closure suspected Pressure above 25mmHg in either eye Abnormal visual fields and/or abnormal optic discs OR OR Reading taken with a Goldmann Tonometer? Patient sent for repeat test with Goldmann’s contact Tonometer* Yes No GP raises referral on E-Referral Pressure reading above 25mmHg in either eye, visual fields normal and optics discs normal Yes No Patient does not meet criteria stated in commissioning policy. Either manage conservatively in the community or consider Individual Funding Request

*Optometrists available to provide Goldman retests Monitoring Monitor at regular intervals people with Ocular Hypertension (OHT) or suspected Glaucoma (COAG) recommended to receive medication (see 'Treatment for people with OHT or suspected COAG'), according to their risk of conversion to COAG (see table 1). Table 1 Monitoring intervals for people with OHT or suspected COAG who are recommended to receive medication Glaucoma NICE clinical guideline 85 *Optometrists available to provide Goldman retests Johnson & Furze Opticians, 7 Chapel Street, THORNBURY, Bristol, BS35 2BJ SFT Optical Ltd T/A Hanham Eyecare, 63 High Street, Hanham, Bristol, BS15 3DG Mike Harbord Opticians Ltd, Whitegates, 3 Flaxpits Lane, Winterbourne,Bristol, BS36 1JX a) Person is treated and IOP is at or below target. If IOP cannot be adequately controlled medically, refer to consultant ophthalmologist. b) To be clinically judged in terms of age, IOP, CCT, appearance and size of optic nerve head. c) For change of treatment plan refer to treatment recommendations. d) For people started on treatment for the first time check IOP 1 to 4 months after start of medication.