NHS Forth Valley

NEW REFERRALS

What happens when I’m referred to the eye clinic?

All referrals are screened by a consultant ophthalmologist who reviews the information from the referrer such as examination findings, treatment thus far and your other relevant medical health problems to decide how quickly you are seen and which specialist is best positioned to manage your problem. Rest assured this thorough process aims to triage the referrals so those whose conditions need the most immediate attention are prioritised.

We all appreciate how important our eyes and sight are and how important it is to you to get a diagnosis and treatment as soon as possible however, worldwide the demand on ophthalmic healthcare service far outweighs the existing healthcare resources so all eye departments operate safe systems to ensure those who clinically need seen first are seen first. Many eye conditions do not require time sensitive treatment i.e. the time before treatment is commenced has no impact on the success of the treatment.

PANDEMIC DELAYS TO CARE

When will I hear an update on the date of my clinic?

In line with national guidance and the need for healthcare to rapidly adapt as the pandemic evolves most outpatient clinics are only booking appointments two weeks in advance. We apologise for the short notice but hope you appreciate the rationale.

When will my follow up appointment be if it is delayed?

Consultants have reviewed the case records of all our existing patients and stratified the urgency of review to ensure we see the patients with the most time sensitive care need first.

What measures is the ophthalmology service in NHS Forth Valley taking to mitigate the delays induced by the pandemic?

NHS Forth Valley was the first and leading health board to introduce teleophthalmology to facilitate consultant advice, decision making and prescribing into community optometrists practices in order to deliver more efficient, more timely, more local, eye care to more patients.

Other new models of delivering eye care are virtual clinics. In a virtual clinic a patient attends the eye department to have particular measurements and scans taken of your eye but instead of seeing a consultant the same day the information is reviewed afterwards. The recommendations are then communicated to you. This allows the limited resource of ophthalmic specialist staff to be most efficiently used to see the greatest number of patients compared to the traditional clinic model.

NHS Forth Valley Ophthalmology department continues to evolve services such as this to treat the greatest number of patients in the most timely but safe manner.

If my optometrist or doctor telephones the department can they arrange an appointment sooner?

We have advised referrers it is not possible for us to provide updates due to the dynamic situation and limitation of booking clinics two weeks in advance.

NEW EYE PROBLEMS

Can I self refer to the eye clinic?

No.

The ophthalmology department manages the most complex and serious eye conditions. Highly trained community optometrists (opticians) provide a more immediate and local NHS emergency eye care service. For more serious eye problems that need more specialist treatments or surgery they will liaise with us and we will coordinate to prescribe treatment, review your eye in the optometrist premises by teleophthalmology video call, or organise for you to attend the eye clinic if necessary.

Is there a walk in service to have my eye examined?

No.

In order to best mitigate the risks of Covid-19 virus transmission healthcare services need to carefully control the flow of patients. Therefore, advance booking of appointments is required.

For your and others safety if you have an eye problem out of hours please seek guidance from NHS 24 before travelling to a minor injuries unit.
A&E /ED deals only with life and immediately sight threatening problems. They will triage your eye problem on arrival and may ask you to attend a more appropriate healthcare provider such as community optometrist. If it is deemed necessary to review your eye in the Emergency Department please expect a long wait as they must prioritise life and limb threatening problems before eye problems. Please be mindful that very few acute eye problems cannot wait to be seen during working hours at a community optometrist, many of which are available 7 days a week.

COVID-19 PANDEMIC SAFETY PRECAUTIONS

What measures are being taken to ensure my safety in the ophthalmology department?

In line with national NHS guidance, patients with symptoms of coronavirus infections should self isolate and not attend physical appointments in the department.

If you do attend the department, please do not attend earlier than your appointed time, wear a face covering/mask on entering the hospital, sanitise your hands with alcohol gel provided and follow the signage and instructions of the staff. Please wear your face covering at all times whilst in the hospital unless instructed otherwise by staff. Staff will physically distance where it is clinically possible and we would ask patients to take the same precautions where they can.

Should I attend the Ophthalmology department?

If we have asked you to attend the department it is our professional opinion that it is important for you to be assessed face to face and receive treatment. It is entirely at your discretion to weigh the benefits and risks of attending for an ophthalmology outpatient appointment. If you would prefer to delay your appointment and accept this might delay your care, please contact us back on the number on your appointment letter and we will endeavour to reschedule.

EXISTING EYE PROBLEMS

How do I obtain the results of x-ray scans or specialist tests performed?

Please contact the secretary of the consultant you saw and leave a message for their attention. They will get back to you with results. Please note most results for most radiology scans i.e. CT or MRI take between 2 and 3 weeks after the scan.

What has happened to the Clinical Priority Service?

In order to better meet the needs of our patients and the ever increasing demand on the ophthalmology service in NHS Forth Valley, the consultants have made the decision to discontinue the clinic priority service and replace it with a clinical advice telephone line for select eye conditions which are likely to recur or deteriorate.

Going forward if you have deterioration of an existing eye condition for which you have previously been issued the clinic priority form, we would ask you to call us on the same number for clinical advice. We will direct you accordingly. It is quite likely we will ask you to attend a community optometrist rather than the ophthalmology clinic if you need physical assessment.

The consultants have asked that the instructions are strictly enforced and that this service is solely for deterioration of existing problems. New ophthalmic problems should be seen by a community optometrist (optician) without discussion with us to keep the telephone line free for those existing patients needing clinical advice.

Medication enquiries that are unable to be dealt with by the GP should be put in writing to the practitioner you see at the address on the Clinical Advice form who will write to you with a solution. The telephone line will be unable to assist with appointment, waiting list or surgery date administration.

VIRTUAL CLINICS

What is NHS Near Me / Attend Anywhere?

In select cases we may invite patients to consult virtually with us via a secure video call platform approved for NHS use. You will be advised if this is suitable for you and given an appropriate time for your consultation. Please login five minutes in advance to ensure technical glitches when first using don’t delay your appointment. More information can be found here.

What is VCreate?

In select cases we may ask patients to communicate with us via a secure video messaging platform to allow you to provide your ophthalmologist with information on your eye condition at a time convenient to you. Your consultant can later review the information and communicate any recommendations to you. You will be advised if this is suitable for you and given the link to instructional videos.

GLAUCOMA / VIRTUAL CLINICS

What is a virtual clinic?

Glaucoma is a lifelong chronic condition predominantly affecting older patients, consequently UK wide there is a high demand for follow up appointments. In order to meet demand and ensure patients continue to be monitored without delay NHS Forth Valley has begun what are known as ‘virtual’ clinics. In these clinics, qualified staff will collect data through standardised tests which will then be recorded for review by one of the glaucoma specialists at a later date to decide if your condition is stable or requires any changes to management. The level of care is exactly the same as you will be used to, however, you will not physically see the ophthalmologist at your appointment. This allows us to care for a greater number of patients. From a patient perspective we hope this reduces your wait time, provides faster appointments and avoids overdue review delays associated with volume of workload. It also frees face to face appointments with an ophthalmologist for patients needing more complex levels of glaucoma care. Almost all eye departments in the UK and increasingly worldwide are offering virtual glaucoma clinics. In NHS Forth Valley we have been providing medical retina virtual clinics safely for a number of years. Studies in the UK have found the virtual glaucoma clinic to be popular with patients and offering high levels of satisfaction.

Does this equate to a full eye health “MOT” examination?

As with a traditional glaucoma clinic appointment with a consultant, the virtual glaucoma clinic is focused on a detailed assessment of your glaucoma. There are many other conditions of the eye, each with their own separate and different examinations and investigations. If you are attending other clinics in the eye department such as medical retina, diabetic retinal screening or corneal clinic we would ask you continue to attend these. For general eye health checks an annual free NHS eye exam is available at your local community optometrist (optician).

What is involved in the glaucoma virtual clinic?

You will attend the eye clinic at Falkirk Community Hospital as normal where your vision on the eye chart, eye pressure and visual field will be measured, We will also perform a combined photo and scan of the nerve of the eye. Finally a nurse will record some important information. Due to the detailed assessments involved please allow at least an hour for the appointment but we hope you will have a shorter wait than you might be used to in the traditional glaucoma clinic. The only difference is you will not see the ophthalmologist but they will write to you with their opinion afterwards.

What to bring to the clinic?

As part of your assessment please bring your most recent spectacle/contact lens prescription from your community optometrist (optician). If you do not have it to hand please bring your most recent glasses. Please bring a list of your medications including eye drops with details of the doses and frequency of administration.

What happens after your appointment?

Our glaucoma specialists review the detailed history, measurements, photos and scans to determine the rate of progression of your glaucoma. We will then write to you in due course to advise on the outcome of the assessment and the planned follow up. You’re GP and community optometrist (where we have the details on file) will be sent a letter with these details. Any questions you have we will be answered in this letter.

Will I always be seen in the virtual clinic?

On reviewing your glaucoma following the virtual appointment we may advise that it is stable and therefore you can continue to be seen in the virtual clinic. Where we feel we need to find out more information or share more information with you, we will invite you to a face to face appointment.

Can I choose to come to a face to face clinic as an alternative?

During the virtual clinic the nurse will enquire if you have any questions for us and we answer in writing when we review your virtual appointment data. We do recognise sometimes patients need a little more assistance and so we are happy to organise a face to face appointment after this virtual review if you feel this would be of help to you. To ensure the patients with the highest clinical urgency are seen promptly we will organise this appointment based on the clinical situation so please be reassured if it is further in the future than you might expect.

Dr David Wardrop – Glaucoma Lead Consultant
Dr Paul Flavahan – Consultant Ophthalmologist
Dr David Miller – Consultant Ophthalmologist
Ms Kate Docherty – Head Optometrist & Glaucoma Specialist
Ms Rachael Callaghan – Glaucoma Specialist Optometrist
Ms Lisa Cowan – Glaucoma Specialist Optometrist

EYE SURGERY

How much notice will I be given of the date for my surgery?

At present, national guidance requires patients to self-isolate where practicable for 2 weeks prior to surgery. Where a general anaesthetic is required Covid-19 testing in advance is mandated. We will let you know as soon as is practically possible of surgery dates. Please bear with us.

When will my cataract surgery be scheduled?

Patients referred for cataract surgery need to have a face to face appointment where measurements for surgery are taken, clinical assessment is made and a discussion regarding risks, benefits and alternatives of surgery can take place. Sight loss from cataracts is a gradual process and whilst it can be debilitating, be reassured it is unlikely to deteriorate fast. Cataract surgery is non-emergency elective surgery. The department is working tirelessly to deliver cataract surgery to those that need it but we would ask for your cooperation as we balance urgent eye surgery against elective surgery and comply with the necessary precautions of delivering hospital care during a pandemic.

All eye departments in the UK are facing the same challenges and our waiting times in NHS Forth Valley are comparable. The national waiting times hospital at the Golden Jubilee National Hospital is operating with the same challenges and restrictions, it is therefore unlikely your surgery will happen any sooner there or in any other health board during the pandemic.

Do I need to self-isolate / shield in advance of eye surgery?

Please follow the instructions of the surgery booking staff who contact you, as guidelines may change. Currently NHS Forth Valley follows NICE guidance: patients are asked to practice social distancing measures 2 weeks in advance of eye surgery, have a Swab test 3 days prior to surgery, and self-isolate between swabbing and surgery.

Which consultant will perform my eye surgery?

In order to offer patients their surgery as soon as possible you may be offered surgery with a different ophthalmology consultant than the one you met at your outpatient appointment. Waiting for a specific consultant may necessitate a longer wait for surgery.

Can I get patient transport to my eye surgery?

At present due to staggered theatre admission times to ensure physical distancing patients cannot use hospital transport to attend day surgery at Falkirk Community Hospital.