Table 2

Case histories

IDCase history and detection pathwayPost-detection pathway to specialist glaucoma services
01Detected on first ever visit to optometrist
Noticing eyes watering and blurry when reading.
Spontaneous decision to go to supermarket optometrist
Patient told by optometrist to phone eye clinic for an appointment
3 months from referral (patient phone call) to eye clinic appointment
02Routine eye tests every 1–2 years. Wore glasses. Advanced normal tension glaucoma detected by ‘photograph’ at first visit to ‘new’ optometristPatient opted for private first consultation to minimise any opportunity for delay. Saw private consultant within 2 weeks. Commenced on ocular hypotensive therapy (Travoprost) and referred to specialist National Health Service eye clinic
03Detected on first ever visit. Patient had not noticed anything was wrong. Supervisor at work noticed increasing frequency of mistakes at work, suggested eye test and booked an appointmentGot letter back from hospital eye clinic within 2 weeks of optometrist referral. Appointment was in 2 months’ time
04Same optometrist for 8 or 9 years.
Reporting severe headaches over eyes at last two appointments and problems with glare. Made GP appointment to discuss severity of symptoms
GP referred patient to cataract clinic
Glaucoma detected at cataract clinic
Cataract clinic appointment from GP took 4 months
Cataract clinic initiated ocular hypotensive therapy and referred patient to glaucoma clinic (patient reports having to stay at cataract clinic for 3.5 h while they tried to reduce pressures)
05Detected at first optometrist appointmentPatient unsure of exact timescale but ‘not long
06Been to optometrist since age of 8. Annual visit from age of 40 due to family history of glaucoma
1992: optic disc haemorrhage detected by optometrist. Patient reports no action taken by GP or two optometrists (second optometry opinion sought by patient due to family history)
1994–2003: optic nerve changes noted (increasing cup to disc ratio and between-eye asymmetry in 1999). Patient reporting pain in right eye+headaches+increasing problems with night and then all glare
2000–2002: reporting falls, difficulty crossing road, glare, accommodating to bright/dim light
2003: glaucoma detected by high street optometrist near to her place of work. Appointment made after patient broke her glasses in a fall
Advanced glaucoma diagnosed at first appointment with consultant ophthalmologist
15 weeks between detection by optometrist and being seen at glaucoma clinic
07Routine eye test every 2 years. Same optometrist for many years. He retired, glaucoma detected on next routine visit to his replacementAttended hospital eye clinic within 2 days of seeing new optometrist
08Referred to hospital with high pressures 30 years ago, attended eye clinic, but reports being discharged after a few visits. Routine sight tests every 2–3 years since then
When glaucoma detected it was 3 years since last full eye check
Patient given letter to take to GP. Patient saw GP the next day
Eye clinic phoned patient, 7 days after she saw GP, asking her to attend eye clinic the following week
09Wore glasses for reading, but had not had an eye test for >10 years
Started to notice things looked a different colour through one eye Optometrist referred patient to cataract clinic
Saw GP within 3 days of seeing optometrist
Patient received letter from hospital with a ‘password’. Patient then had to ring hospital to make appointment
Attended hospital appointment (at cataract clinic) within 2–3 weeks, but on first visit was told she was in the wrong place and ‘quickly’ referred her on to her current glaucoma specialist
10Annual eye checks, cataracts and glaucoma detected at routine visit. Detected by an optometrist that patient had seen on previous appointmentsOptometrist referred patient to GP (by letter)
GP wrote to patient informing him that an appointment had been made at the hospital. Attended hospital appointment approximately 2 months later
11Detected at annual eye check
With hindsight patient reports pain above the eyes at night (throbbing) for 1 month prior to optometrist appointment, thought it was ear ache
Optometrist referred to GP. GP contacted the hospital
Patient reports attending ophthalmology clinic the day after GP informed by optometrist. Given letter from optometrist/GP to take with her