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Written on 18th February 2020 by

Glaucoma is the leading cause of blindness in the UK. It is caused by damage to the optic nerve from the pressure of the fluid in the eye. In the UK it is estimated that two percent of the population over the age of 40 have glaucoma. In England, about 480,000 people have chronic open-angle glaucoma which is the most common type of glaucoma.

Recent reports from both Getting It Right First Time (GIRFT) and the Healthcare Safety Investigation Branch (HSIB) have highlighted serious concerns relating to delays in monitoring and treating patients with glaucoma. As a result of such delays, patients have suffered irreversible blindness.

Are there different types of glaucoma?

The Royal National Institute of Blind People (RNIB) set out the different types of glaucoma on their website:

  • Primary open angle glaucoma (also known as chronic open angle glaucoma) –  damage to the optic nerve and changes to vision occur slowly over time;
  • Closed angle glaucoma – damage to the optic nerve can happen suddenly from a sudden rise in eye pressure;
  • Normal tension glaucoma – where normal eye pressure causes damage to the optic nerve;
  • Secondary glaucoma – caused by another eye condition, an eye injury or medication;
  • Congenital glaucoma – when a baby has glaucoma at birth.

How is glaucoma treated?

Treatment for glaucoma aims to lower the pressure in the eye to prevent damage to the optic nerve and sight. Many people can manage the condition with eye drops which reduce the eye pressure. Some people may need surgery if the condition cannot be managed with eye drops.

The most common type of glaucoma, primary open angle glaucoma, is progressive.  Timely intervention and treatment is crucial to prevent the condition worsening leading to irreversible sight loss.  

Getting it Right First Time

Getting It Right First Time (GIRFT) is a national programme designed to improve NHS care by reducing variation in the way different NHS trusts provide NHS services. GIRFT identifies changes to improve care and outcomes for patients. GIRFT then shares these findings to encourage the everyone to learn from the trusts which are using the best practises. It also finds ways to make the NHS more efficient to save unnecessary costs.

In December 2019, a GIRFT report on ophthalmology treatment in England was published. The authors of the report, who are NHS clinicians, visited ophthalmology teams in 120 trusts across England. They found that the demand for ophthalmology services is increasing. Referrals from primary care are up by 12% since 2013/2014. Referrals are expected to increase further in the future as the result of the ageing population.

Glaucoma treatment was one of the key areas discussed in the GIRFT ophthalmology report. Areas of concern included differences in the way ophthalmology referrals are made, leading to large numbers of ‘false positive’ results. Meanwhile, for glaucoma patients receiving treatment, many Trusts offer similar levels of monitoring for all patients, even though there are different levels of risk of disease progression.

GIRFT highlighted that higher risk patients need close monitoring and timely medical and/or surgical intervention. Others need careful but less frequent monitoring. Finally, those at the lowest risk of vision loss can be monitored by optometrists, ophthalmic nurses or orthoptists.

GIRFT finds widespread delays in treatment for glaucoma patients

One of the most concerning findings was that 89% of the trusts that the GIRFT team visited said that there was some delay in follow up treatment for glaucoma patients. 43 providers reported that follow-up had been delayed for more than 500 glaucoma patients in the previous year.

The GIRFT recommendations were:

  1. To reduce the rate of false positive referrals for patients with glaucoma by bringing in consistent criteria in line with NICE Guidance.
  2. A model pathway should be agreed for monitoring glaucoma patients. This would make sure that patients are treated by the appropriate professional for their level of risk of sight loss. There would be ‘virtual clinics’ for glaucoma patients at low risk of vision loss. Staff would be educated about discharge policies.
  3. In 2018, NHS England issued High Impact Interventions (HII) to help to minimise the risk of harm for patients with chronic eye conditions. GIRFT recommended implementation of HII actions to ensure failsafe prioritisation for all ophthalmology patients.

Healthcare Safety Investigation Branch

The Healthcare Safety Investigation Branch (HSIB) was established in 2017 to carry out independent investigations into patient safety concerns in the NHS in England. According to HSIB’s website, their purpose is to ‘improve patient safety through effective and independent investigations that do not apportion blame or liability.’

Last month the Healthcare Safety Investigation Branch (HSIB) published a report on the lack of timely monitoring in patients with glaucoma. HSIB highlighted the case of a 34-year-old woman who lost her sight to glaucoma as a result of 13-month delays in follow-up appointments. HSIB drew on research which suggests that 22 patients a month suffer severe or permanent sight loss as a result of delays in their care.

The HSIB report reinforced the findings in the GIRFT report. Their findings included that there is inadequate capacity to meet the demand for glaucoma services; a significant number of patients referred by primary care providers are subsequently found not to have glaucoma; and that because there are significant differences in the risk of vision loss among glaucoma patients, patients must be categorised and treated according to their risk of sight loss.

How we can help?

Glaucoma is a life-long condition. With early diagnosis, many glaucoma sufferers can manage their condition with eye drops throughout their life. However, the reports of GIRFT and HSIB indicate that many glaucoma patients experience unnecessary delays in monitoring and treatment. Delay can result irreversible blindness.

We know from our clients that this life-changing injury causes distress and disability, and often results in a long period of adaptation and rehabilitation. We have helped clients with permanent sight loss claim compensation to help them adjust to life following their injury.

A legal claim can help to secure compensation for:

  • pain, suffering and loss of amenity suffered as a result of the injury
  • the costs of employed carers and domestic assistance
  • the costs of therapies, such as counselling and occupational therapy
  • the costs of medication or private health care, including further surgery or treatment
  • the costs of travel
  • loss of earnings
  • the cost of aids, equipment and prostheses, such as walking aids and cosmetic shells
  • the cost of assistive technology such as voice recognition technology
  • the costs of adaptations to the home
  • specialist education (for children)

If you have suffered sight loss from medical negligence and would like to find out more about making a claim, contact us by email at mednegclaims@boyesturner.com or for more information about sight loss visit the Royal National Institute for the Blind website.