1. Managing patients with eye problems a guide for GPs and Pharmacists

2. Eye examination types available from optometry practices Private – fees vary GOS – NHS funded for certain categories of patients Minor Eye Conditions Service – CCG funded for certain categories of patients

3. Who is entitled to a GOS examination? Under 16 and those over 60 years old People 40 and over with a family history of Glaucoma People who have Diabetes Mellitus or Glaucoma People in receipt of certain benefits e.g. Income Support, Tax Credit, Pension Credit, Universal Credit

4. GOS eye examinations –No charge to the patient –Prescriptive and restrictive –Only at certain intervals –Nowadays many practices offer ‘enhanced examinations’ for an additional fee Traditional ‘NHS sight tests’

5. MECS – what is it? Minor Eye Conditions Service is a community optometry based service to Assess Diagnose Treat eye conditions not requiring specialist care and Refer as required, to GP with advice or to intermediate / secondary ophthalmology

6. MECS - The aim of the pathway is to: provide a timely assessment of the needs of a patient presenting with an eye condition reduce unnecessary referrals to the hospital eye services reduce patient anxiety and increase capacity within the overburdened hospital eye health services provide a more cost effective service with a greater number of patients being managed within the community setting

7. Who is entitled to MECS Any patient registered with a SWBCCG or Solihull GP practice. Under 16s need a responsible adult in attendance. Enables early and quick assessment of “worrying” eye conditions.

8. Eye problems suitable for MECS Anyone with an eye problem that you feel needs urgent differential diagnosis – usually based on symptoms Patients can self-refer or a GP can request an appointment Optometrists have been specifically trained, accredited and their practices must have certain equipment to provide MECS

9. MECS – Loss of vision including transient loss Sudden onset of blurred vision but always consider if a sight test would be more appropriate Ocular pain or discomfort Differential diagnosis of a red eye Foreign body and emergency contact lens removal Dry eye Epiphora (watery eye) Trichiasis (in growing eyelashes)

10. MECS - Recent onset of Diplopia Systemic disease affecting the eye Flashes/floaters Retinal lesions Patient reported field defects Differential diagnosis of lumps and bumps in the vicinity of the eye

11. MECS - exclusions Diabetic retinopathy Patients not due for retinopathy screening consider a routine sight test Adult squints, long standing diplopia Refer for a routine sight test Repeat field tests to aid diagnosis following an eye examination Not sure - telephone a participating practice for advice

12. MECS Patients can be sent to any accredited optometrist practice – a list of practices is available at www.eyecarewm.co.uk Practices will always try to fit patients in within 24 hours – but if not possible our “buddy” system, with local colleagues, will find an available appointment when needed. But a first approach by telephone may be best

13. Optometrists responsibility to GP A report to GP within 2-3 days for non-urgent cases A fax or phone call to the GP on same day if patient requires urgent referral When managing a patient with a minor ocular disorder the GP must be informed

14. Causes of red eye