Preventing delay to follow-up for patients with glaucoma

This Rapid Response Report recommends that NHS organisations act to minimise the risk of avoidable sight loss for patients with established or suspected glaucoma.

Primary open angle glaucoma is a progressive eye disease affecting about 2% of adults over the age of 40, and is capable of causing severe sight loss. This can be greatly reduced by early detection, medical or surgical treatment. Lifelong follow-up at regular intervals is essential.

Between June 2005 and May 2009, the National Reporting and Learning Service (NRLS) received reports of 44 glaucoma patients who experienced deterioration of vision, including 13 reports of total loss of vision, attributed to delayed follow-up appointments. A further 91 incidents related to delayed, postponed or cancelled appointments, but the level of harm is not known.

Local healthcare organisations should:

1. Make National Institute for Health and Clinical Excellence (NICE) glaucoma guidelines available to staff. Develop an action plan to implement the recommendations.
2. Review levels of hospital-initiated appointment cancellations for patients with established or suspected glaucoma.
3. Identify and audit high-risk non-attending patients.
4. Identify the number of patients currently awaiting follow-up. Confirm the capacity for  outpatient appointments and any specialist investigations.
5. Develop a means of indicating the clinical priority given to appointments on the booking system. Monitor activity to ensure compliance with NICE follow-up intervals.
6. Provide patients with glaucoma information. Ensure they can easily reschedule appointments when necessary.