GP INFORMATION - City & Hackney

Minor Eye Conditions Community Service (MECs) is an NHS funded service available to all patients registered with an Islington GP. Assessment and treatment of recently occurring medical eye conditions is provided by local optometrists with the specialist knowledge and skills to carry out this work.

The service does not replace the routine eye examination, eye tests or prescriptions for spectacles. A sight test is not performed as part of the assessment or treatment, and prescriptions are not offered for spectacles. The service also offers glaucoma repeat measurement and refinement and cataract screening.

Optometrists at the approved sites will offer repeat glaucoma IOP and or fields measurements for patients.

The patient attends the full cataract assessment to elicit relevant ocular, medical and social information which will assist secondary care facilities in ensuring the patient receives the most appropriate treatment and care. This will include:

• pupil dilation and examination by indirect ophthalmoscopy in order to establish whether there are any co-existing ocular disorders as well as cataract
• provision and discussion of a cataract patient information booklet which includes the patient feedback questionnaire and patient health questionnaire, and any outstanding issues dealt with
• communicating the relative risks and benefits of cataract extraction
• shared clinician/patient decision making using an appropriate tool
• ascertaining the patient’s willingness for surgery

Patients presenting the following conditions will be seen by the MECs service:

• loss of vision including transient loss [consider differential diagnosis (TIA, Temporal Arteritis)]
• ocular pain
• systemic disease affecting the eye
• differential diagnosis of red eye
• foreign body and emergency contact lens removal (not by the fitting practitioner)
• dry eye
• epiphora (watery eye)
• trichiasis (in growing eyelashes)
• differential diagnosis of lumps and bumps in the vicinity of the eye
• recent onset of diplopia [consider stroke; binocular diplopia always significant]
• flashes/floaters
• retinal lesions

• patients that have been assessed under an GOS or private eye examination and found to fall into the categories for repeat measurement and refinement
• OR patients who have been routinely referred (by GP or other appropriate clinician) for glaucoma assessment
• OR the patient’s GP feels for any reason that this patient should have a glaucoma assessment
• AND who have high intra-ocular pressures that have not been measured using a Goldmann or Perkins applanation tonometer
• AND who have no other significant clinical signs of glaucoma

To be eligible the patient must fulfil ALL of the following criteria:

• have cataracts/PCO and present with symptoms
• want to be considered for cataracts/PCO surgery
• the patient’s lifestyle is affected by the cataracts/PCO (patients can be referred with any level of visual acuity)
• cataract/PCO is the main cause of the patients reduced vision or symptoms
• no other relevant co-morbidity
  • practitioners are expected to use their own clinical judgment if a patient has macular degeneration on whether the patient can be referred for cataract surgery
  • diabetic patients with no diabetic retinopathy or background retinopathy will be accepted on the scheme.

Patients with the following condition cannot be seen by the MECs service

• severe ocular pain requiring immediate attention
• severe infection
• suspected retinal detachment
• retinal artery occlusion
• chemical injuries
• penetrating trauma
• orbital cellulitis
• temporal arteritis
• ischaemic optic neuropathy
• binocular double vision

The treatment of long-term chronic conditions is not included within the service:

• diabetic retinopathy
• long-standing adult squints
• long-standing diplopia

• if the patient is already under the care of an ophthalmologist, they are excluded from this scheme and must be referred via their GP for consideration of cataract/PCO surgery.