Selective laser trabeculoplasty (SLT) performed by optometrists—enablers and barriers to a shift in service delivery

Abstract

Background/objectives To explore the acceptability, training requirements, enablers and barriers of optometrist-delivered SLT. Subjects/methods Optometrists, fellowship and consultant grade ophthalmologists, hospital managers and patients were interviewed using pre-defined topic guides. Interviews were audio-recorded, transcribed, and subjected to thematic analysis. Overarching themes were defined by the study aims and the topic guides; subthemes were derived from the interview data. Results Sixty-six participants (three managers, eight glaucoma specialist consultant ophthalmologists, seven clinical glaucoma fellows, 12 optometrists (two of them performing SLT), two ophthalmic nurses and 34 patients) participated in the study. Overarching themes (and subthemes) were: necessity of non-medical SLT delivery, clinical practice and training, advantages, disadvantages, concerns, challenges, community delivery of SLT, patient values and other healthcare professionals that could also deliver SLT. Conclusions Certain clinical pre-requisites, such as gonioscopy and independent prescribing rights, were perceived as necessary for undertaking SLT training. An optometrist-delivered SLT service was expected to benefit the NHS, but there was an identified need of a standardised training scheme and robust governance. Patients were accepting of an optometrist-delivered SLT service in the hospital eye service.

Providing capacity in glaucoma care using trained and accredited optometrists: A qualitative evaluation

“…The 2022 NICE guidance states those involved in monitoring and treating patients should have a specific qualification in glaucoma [17], and as highlighted in our study, further work evaluating the workforce with glaucoma related qualifications will help support service planners. Regarding accreditation for performing SLT, in keeping with Konstantakopoulou et al, [43], our study emphasises the importance of gonioscopy, laser safety and patient counselling, rather than a specific qualification. Translimbal direct selective laser trabeculoplasty [46], a newer technique currently being evaluated [47], may lead to simplified training, and support an increased workforce for delivering laser.…”

“…Whilst the recent scope of practice of hospital optometrists [ 14 ] showed an increase in numbers of optometrists delivering SLT, greater capacity will be needed to meet NICE recommendations. Recently, Konstantakopoulou et al, conducted qualitative research exploring acceptability, enablers and barriers of optometrists delivering SLT [ 43 ], concluding an optometrist-delivered service could benefit the NHS. Whilst this work offered a useful multi-stakeholder perspective, it was limited to patients and clinicians from one hospital.…”

Optometrist-delivered selective laser trabeculoplasty in the HES – a training protocol and early service evaluation

“…Entry requirements for the course were a minimum of a BSc in Optometry, Orthoptics or Nursing with ophthalmic speciality training equivalent to OPT level 3, the College of Optometrists Glaucoma Higher Certificate or an equivalent qualification and experience, a certified gonioscopy competency and independent prescribing qualifications (or evidence they were supplementary prescribers or could prescribe under a Patient Group Direction). These entry-level criteria were based on previous qualitative work gathering the views of consultant ophthalmologists and optometrists on the development of a laser-training course for nonmedical professionals [27]. The criteria were also supported by evidence that the clinical decision-making of optometrists with higher qualifications or experience in specialist HES clinics is comparable to consultant ophthalmologists [29][30][31] and better than peers without such qualifications [32].…”

“…The RCOphth encourages ophthalmology trainees to practice on model eyes before performing laser procedures [26], but trainees must work under clinical supervision to progress to independently providing laser treatments such as SLT. It has been previously suggested that a structured laser-training programme for optometrists could provide a common basis for standardised training for trainee ophthalmologists [27].…”

“…Building from previous work on the global landscape of nonmedical delivery of SLT [25] and the acceptance of optometrists in such roles [27], here we report the principles and delivery of a laser course for non-medical ophthalmic clinicians delivered by Moorfields Eye Hospital NHS Foundation Trust and the Institute of Ophthalmology at University College London (UCL). The training course is designed for optometrists following established glaucoma training, underpinned by the College of Optometrists Higher Qualifications curricula [22] and the RCOphth OPT curriculum [28].…”