1. Johan Semby Head of Glaucoma Hallands Hospital
How to Save More People from Going Blind from Glaucoma –a Swedish Model
Johan Semby
Head of Glaucoma Hallands Hospital

2. Glaucoma – a Swedish working model
Disclaimer
Glaucoma lectures at different ophthalmology departements sponsored by Alcon
Glaucoma – a Swedish working model

3. Glaucoma – a Swedish working model
A fight against preventable blindness and visual impairment
In Sweden and World Wide
Glaucoma – a Swedish working model

7. Glaucoma – a Swedish working model
The three main causes of blindness world wide
Glaucoma
Cataract
Maculadegeneration
Glaucoma – a Swedish working model

8. Glaucoma – a Swedish working model
The three main causes of blindness world wide are glaucoma, cataract and maculadegeneration.
Glaucoma and diabetes are by far the biggest patient groups within ophthalmology in Sweden, both growing rapidly.
Glaucoma – a Swedish working model

9. Glaucoma – a Swedish working model
The three main causes of blindness world wide are glaucoma, cataract and maculadegeneration.
Glaucoma and diabites are the biggest patient groups within ophthalmology in Sweden
17% of glaucoma patients goes bilateral blind in Sweden during their life time
Glaucoma – a Swedish working model

29. Glaucoma – a Swedish working model
January 2011 –
No guidelines for glaucoma in the State of Halland, Sweden
Glaucoma – a Swedish working model

30. Glaucoma – a Swedish working model
No guidelines for glaucoma in Halland
Judges 21:25 Back in those days, Israel didn't yet have a king, so each person did whatever seemed right in his own opinion.
Glaucoma – a Swedish working model

32. Glaucoma – a Swedish working model
2014 –
A government inspection concluded that patients had become visually impaired because of delay in glaucoma follow up at Hollands Hospital.
Glaucoma – a Swedish working model

33. Glaucoma – a Swedish working model
2014 – a government inspection concluded that patients had become visually impaired because of delay in glaucoma follow up at Hollands Hospital.
I was asked to address the problem.
Glaucoma – a Swedish working model

34. Glaucoma – a Swedish working model
Challenges
Glaucoma – a Swedish working model

35. Glaucoma – a Swedish working model
Challenges
Glaucoma – no glamour
Glaucoma – a Swedish working model

36. Glaucoma – a Swedish working model
Challenges
Glaucoma – no glamour
Number of doctors / nurses / secretaries
Glaucoma – a Swedish working model

37. Glaucoma – a Swedish working model
Challenges
Glaucoma – no glamour
Number of doctors / nurses / secretaries
Resources
Glaucoma – a Swedish working model

38. Glaucoma – a Swedish working model
Challenges
Glaucoma – no glamour
Number of doctors / nurses / secretaries
Resources
Priorities
Glaucoma – a Swedish working model

39. Glaucoma – a Swedish working model
Challenges
Glaucoma – no glamour
Number of doctors / nurses / secretaries
Resources
Priorities
Logistics
Glaucoma – a Swedish working model

40. Glaucoma – a Swedish working model
Logistics
– A main problem in causing blindness
Glaucoma – a Swedish working model

41. Glaucoma – a Swedish working model
Logistics – a main problem in causing blindness
Visual field screening day 1
Glaucoma – a Swedish working model

42. Glaucoma – a Swedish working model
Logistics – a main problem in causing blindness
Visual field screening day 1
Doctor evaluate within 1 month (in reality 3-7 months)
Glaucoma – a Swedish working model

43. Glaucoma – a Swedish working model
Logistics – a main problem in causing blindness
Visual field screening day 1
Doctor evaluate within 1 month (in reality 3-7 months)
Secretary writes evaluation within 4 days (in reality 1-2 months)
Glaucoma – a Swedish working model

44. Glaucoma – a Swedish working model
Logistics – a main problem in causing blindness
Visual field screening day 1
Doctor evaluate within 1 month (in reality 3-7 months)
Secretary writes evaluation within 4 days (in reality 1-2 months)
Nurse book patients for new visual field (1-7 months delay)
Glaucoma – a Swedish working model

45. Glaucoma – a Swedish working model
The patient expects an answer within 1 month
In reality a delay of 5 – 15 months
Glaucoma – a Swedish working model

46. Glaucoma – a Swedish working model
Solution
– Delegation
Glaucoma – a Swedish working model

47. Glaucoma – a Swedish working model
Solution – Delegation
Let the nurse make a primary evaluation of the visual field
Glaucoma – a Swedish working model

48. Glaucoma – a Swedish working model
Solution – Delegation
Let the nurse make a primary evaluation
If stable (around 80%) nurse tell the patient directly, and rebook directly according to doctors plan or guidelines.
Glaucoma – a Swedish working model

49. Glaucoma – a Swedish working model
Solution – Delegation
If stable (80%) nurse tell the patient directly, and rebook directly according to doctors plan or guidelines.
= no doctor, no secretary, no letters, no phone calls… but a lot of less time and money
Glaucoma – a Swedish working model

50. Glaucoma – a Swedish working model
Let the nurse make a primary evaluation
= happier patients (answer wright a way)
Glaucoma – a Swedish working model

51. Glaucoma – a Swedish working model
Let the nurse make a primary evaluation
= happier nurses (no angry phone calls from patients that been waiting 5 months or more)
Glaucoma – a Swedish working model

52. Glaucoma – a Swedish working model
Let the nurse make a primary evaluation
= happier doctors (much less paperwork)
Glaucoma – a Swedish working model

53. Glaucoma – a Swedish working model
… And as a nice side effect:
= less visual impairment because of doctors delay
Glaucoma – a Swedish working model

54. Glaucoma – a Swedish working model
Is it that easy?
Glaucoma – a Swedish working model

55. Glaucoma – a Swedish working model
Is it that easy?
It takes a change of heart
Glaucoma – a Swedish working model

56. Glaucoma – a Swedish working model
Is it that easy?
It takes a change of heart
It takes a change of mind
Glaucoma – a Swedish working model

57. Glaucoma – a Swedish working model
Is it that easy?
It takes a change of heart
It takes a change of mind
Sometimes it is easier to wonder to the ends of the earth rather then the distans between the mind and the heart
Glaucoma – a Swedish working model

58. Glaucoma – a Swedish working model
So what do we need to do?
Glaucoma – a Swedish working model

59. Glaucoma – a Swedish working model
So what do we need to do?
Motivate nurses
Glaucoma – a Swedish working model

60. Glaucoma – a Swedish working model
So what do we need to do?
Motivate nurses
Train nurses
Glaucoma – a Swedish working model

61. Glaucoma – a Swedish working model
So what do we need to do?
Motivate nurses
Train nurses
Create s secure environment for the nurses
Glaucoma – a Swedish working model

62. Glaucoma – a Swedish working model
The key to make secure nurses are motivated and supportive doctors that gives clear directions.
Glaucoma – a Swedish working model

63. Glaucoma – a Swedish working model
Doctors need to…
Glaucoma – a Swedish working model

64. Glaucoma – a Swedish working model
Doctors need to…
Be motivated and trained to follow guidelines
Glaucoma – a Swedish working model

65. Glaucoma – a Swedish working model
Doctors need to…
Be motivated and trained to follow guidelines
Establish target pressure
Glaucoma – a Swedish working model

66. Glaucoma – a Swedish working model
Doctors need to…
Be motivated and trained to follow guidelines
Establish target pressure
Write follow up plan for each patient that are at higher risk
Glaucoma – a Swedish working model

67. Glaucoma – a Swedish working model
Doctors need to…
Be motivated and trained to follow guidelines
Establish target pressure
Write follow up plan for each patient that are at higher risk
Define deviation allowed on visual field tests
Glaucoma – a Swedish working model

68. Glaucoma – a Swedish working model
Motivate patients
Glaucoma – a Swedish working model

69. Glaucoma – a Swedish working model
Motivate patients
Glaucoma – More the doctors problem then the patient
Glaucoma – a Swedish working model

70. Glaucoma – a Swedish working model
Motivate patients
Glaucoma – often more the doctors problem then the patients
Inform at nurse level and doctors level
Glaucoma – a Swedish working model

73. Glaucoma – a Swedish working model
Priorities
We only have this much resources.
Glaucoma – a Swedish working model

74. Glaucoma – a Swedish working model
Priorities according to risk profile
Glaucoma – a Swedish working model

75. Glaucoma – a Swedish working model
Priorities according to risk profile
Delegate to the commercial market those at low risk
Glaucoma – a Swedish working model

76. Glaucoma – a Swedish working model
Priorities according to risk profile
Delegate to the commercial market those at low risk
Make longer time between follow up for low risk patients – so that the high risks always get in time
Glaucoma – a Swedish working model

79. Glaucoma – a Swedish working model
Team work
Glaucoma – a Swedish working model

80. Glaucoma – a Swedish working model
Team work
Engage the whole state
Glaucoma – a Swedish working model

81. Glaucoma – a Swedish working model
Team work
Engage the whole state
All hospitals
Glaucoma – a Swedish working model

82. Glaucoma – a Swedish working model
Team work
Engage the whole state
All hospitals
All private clinics
Glaucoma – a Swedish working model

83. Glaucoma – a Swedish working model
Team work
Engage the whole state
All hospitals
All private clinics
All optrisens / eye shops
Glaucoma – a Swedish working model

84. Right eye - man born1942

85. Right eye - man born1942

86. Höger Man f.42