Quality statement 5: Reassessment – chronic open angle glaucoma or related conditions
Quality statement
Adults with chronic open angle glaucoma (COAG) or related conditions have reassessment at specific intervals.
Rationale
Reassessment is important for identifying clinically significant changes in adults with COAG or adults at risk of conversion from ocular hypertension (OHT) or suspected COAG to COAG. Reassessment also supports maintaining a consistent intraocular pressure (IOP). Providing tailored treatment in response to disease progression and maintaining IOP levels reduces the risk of significant sight loss, and reduced quality of life.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local arrangements to ensure that adults with COAG or related conditions have reassessment appointments scheduled at specific intervals, according to their risk of conversion to COAG or progression to sight loss.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, service specifications and local protocols.
Process
a) Proportion of adults with COAG or related conditions who have reassessment at specific intervals.
Numerator – the number in the denominator who have reassessment at specific intervals.
Denominator – the number of adults with COAG or related conditions.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, patient records and appointment systems.
b) Proportion of scheduled reassessment appointments for COAG or related conditions that are cancelled or delayed by the service provider.
Numerator – the number in the denominator that are cancelled or delayed by the service provider.
Denominator – the number of scheduled reassessment appointments for COAG or related conditions.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, patient records and appointment systems.
c) Proportion of hospital appointments for adults with COAG or related conditions that occur within 25% of their intended reassessment period, including rescheduling of hospital cancellations and non-attendance by adults with COAG or related conditions.
Numerator – the number in the denominator that occur within 25% of their intended reassessment period.
Denominator – the number of reassessment appointments scheduled, including those rescheduled after hospital-initiated cancellation and non-attendance by adults with COAG or related conditions.
Data source: NHS England's Elective care transformation programme: Transforming elective care services: ophthalmology includes an indicator in this area. Local data collection, for example, clinic attendance and cancellation records.
Outcome
a) Loss of vision for adults with COAG or related conditions (visual field loss, changes to visual acuity).
Data source: Database audit – National Electronic Glaucoma Surgery and Visual Field Preservation Audit feasibility report contains: rates of visual field loss in the worst eyes (figure 44), speed of visual field progression (figure 45), and loss of sight years (table 11). Data were last collected in 2015 from 5 major glaucoma centres. Available from the Royal College of Ophthalmologists' National Ophthalmology Database Audit.
Local data collection, for example, patient records and local ophthalmology records of patient safety incidents.
b) Health-related quality of life for adults with COAG or related conditions.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, a questionnaire.
What the quality statement means for different audiences
Service providers (NHS hospital trusts and community optometry services) have agreed protocols to ensure that adults with COAG or related conditions have reassessment at specific intervals, according to their risk of progressive sight loss.
Healthcare professionals (such as ophthalmologists, advanced nurse practitioners, optometrists and orthoptists) carry out reassessment for adults with COAG or related conditions at specific, clinically appropriate intervals, according to their risk of progressive sight loss.
Commissioners (clinical commissioning groups) ensure that services provide reassessment for adults with COAG or related conditions at specific intervals, according to their risk of progressive sight loss.
Adults with glaucoma, suspected glaucoma or ocular hypertension have regular assessments to minimise their risk of sight loss. How often they have an assessment will depend on how well the treatment seems to be working.
Source guidance
Glaucoma: diagnosis and management. NICE guideline NG81 (2017, updated 2022), recommendations 1.5.9, 1.5.11, 1.5.12 and 1.5.13
Definitions of terms used in this quality statement
Specific intervals for reassessment of COAG or related conditions
Specific intervals for reassessment depend on the risk of progression to sight loss, as set out in tables 1 to 3 in NICE's guideline on glaucoma. Clinical judgement is used to decide when the next appointment should take place within the recommended interval.