1. 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

2. *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.