update royal college guidelines for ocular 青光眼眼皇家学院指南更新课件

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1、NewCarePathwaysinGlaucomaStephenA.VernonDMFRCSFRCOphthDODEPARTMENTOFOPHTHALMOLOGYUNIVERSITYHOSPITALNOTTINGHAMUKUKpopulationbyage-2001AgerangeBMESPREVALENCEOFPOAG<6060-6970-79>80AgeGroupEstimatednumbersofglaucomasinUKbyageAgeNoin1000sEstimatednumbersofglaucomasinUKbyageAgeNoin1000sOver65st

2、oincreaseby20-25%by2020NodiseaseClearcutdiseaseAgeingincreasessizeofgreyareaOverlapsdependondefinitionsGreyareaAmodelofonsetofaslowlyprogressivedegenerativediseaseFactorsdrivingchangeinglaucomaElderlypopulationincreasingMorecasesdetected(espNTG)Lowratioofophthalmol.:patientsinUKIncreasing

3、specialisationandinvestigationsChangesintrainingreducesclinicstaffDriveforlowtargetpressures–morevisitsMedicalmanagementoptionsgreater-morevisitsDemandfor“patientcentredcare”–patientchoice,C&BNewtargetsforfirstOPDvisitsleadtobow-waveoffollowuppatientsDesireofPCTtosavemoneyPaymentbyresults

4、TheOptometristslobby.DemographicdetailsofpresentingpatientsPast(1980)63%viaoptometristsMeanage70.6MeanIOP31.7mmHg33%late10%regblindfewfalsepositivesDemographicdetailsofpresentingpatientsPresent98%viaoptometristsMeanagereducingMeanIOPreducingfewerpresentlateraretoregisterblindatpresentatio

5、nfalsepositivereferralsaproblemPercentageofreferralsdiagnosedasnormalatfirstSAVGlaucomaClinicDiagnosticbreakdown2000–SAVclinic%Nearly30%OHTandsuspectsTypicalEyedepartmentincreaseinOutpatientvisitsNewmedshaveloweredsurgicalratesIncreaseinglaucomamedicationsprescribed1995-2004totalAllBetabl

6、ockersXalatanTimololCosoptUKdatabymonthTheglaucomaclinicsnowballphenomenonWorkloadcalculationforUKophthalmologists380,000glaucomapatientsinUK540patientsperconsultantAverage2.5visits/yr1600visits/yr3clinicsavailable533visitsperclinicfor42weeks13glaucomapts/clinic(ifalldiagnosed)Workloadcal

7、culationforUKophthalmologists13glaucomapts/clinic(ifalldiagnosed)50%diagnosedBut200suspectreferrals/yr+reviewsuspects/OHT6perclinic12.5glaucomarelatedpatientseveryclinicIfallconsultants“do”glaucomaGlaucomaaccountsforonly25%ofOPDvisitsThecurrent“English”carepathwaySu