Postby Lynn White » Wed 29 Mar 2006 4:36 pm
Keratoconus in the UK - patient guide
NHS referral pathways
The NHS has a set referral pathway. If you have an eye test and keratoconus is suspected, the optometrist refers you to the GP with a recommendation to refer you to an ophthalmologist. An optometrist has no direct referral right.
The GP will refer onwards and you will receive an appointment from the hospital to attend the clinic of a consultant ophthalmologist. He or she will examine you and if KC is confirmed - then you are given the diagnosis.
If contact lenses are considered suitable, you will then be referred to the contact lens department in the hospital - if it has one. In cases where there is no CL dept, you may well be referred back to an optometrist near to you for contact lens fitting. If you are eligble, then you may receive a hospital voucher towards the cost of the contact lenses.
National policy
There is no national policy because the NHS is organised into local PCT's "Patient Care Trusts" which replace earlier "Health Authorities". Each PCT arranges its own policy and contracts out to optometrists in slightly different ways. Hence you will find that treatment and management of keratoconus will vary markedly according to your postcode.
Types of contact lenses
The type of contact lens you are given again often depends on postcode. This is more due to the fact that KC is an uncommon condition and therefore experience with the condition varies widely across the country. Hospital optometrists come and go - often contact lens departments are manned by private optoms who are invited in to do clinics - so the type of lens you are fitted with may even depend on which day you are seen in the clinic as a particular optom may only be there once a week!
Optometrists vary in their experience and since much of this is gained in private practice - to a certain extent, this experience is dictated by what patients they see and the commerical viability of fitting many different types of lenses. It is simply not viable for a private practice to buy in many different fitting sets for a condition that in the high street may only be seen once every few years.
Although in a hospital environment, more fitting sets are available - again, they are dependent on the experience of the optometrists fitting them!
Also, different consultants favour different techniques and so may decide what lenses are going to be fitted and that is what the optometrist has to do - at least in the first instance. If this is unsuccessful, then they may well suggest another type of lens.
Optometrists
Optometrists are trained to "refract" - that is test the eyesight of a patient in order to obtain a "prescription". From this a pair of spectacles can be made. In the UK, optometrists also are required to examine the eye for diseases, which, under law, they can "recognise" not diagnose.
If they discover any pathology, they must refer on to the GP who then refers on to the consultant.
It is the optometrist - either in hospital or in private practice - who will fit the contact lenses after the diagnosis by the consultant.
Optometrists have no control over therapy - this is decided by the consultant who should keep the GP informed. Quite often, the optometrist does not receive any feedback from the hospital or GP.
Consultants
Consultants are medical doctors who have qualified as ophthalmologists.
Within the NHS system, if an optometrist suspects a patient has KC, they refer to the hospital via the GP. The consultant then is reponsible for diagnosis and deciding therapy. This may mean the patient is referred to the contact lens department in the hospital.
In some circumstances, the consultant may refer to a private optometrist for contact lens fitting.
It is the consultant who decides the form of therapy - not the optometrist. So, it is only the consultant who can suggest a corneal graft. They also have the sole power to register a person blind or partially sighted.
Again, this is copied directly from my old files so any commented on what needs to be expanded or left out - just shout..
