Edinburgh's Eye Pavilion: Dispersing eyecare services would be 'recipe for disaster' expert warns

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Brian Fleck, a retired consultant ophthalmologist at the Eye Pavilion and honorary professor of ophthalmology at Edinburgh University, said: “If the Eye Pavilion were to close and not be replace and services were 'dispersed' it's difficult to see how quality ophthalmology services could be preserved in Lothian.”

The future of eyecare services in Lothian remains uncertain after the Scottish Government said in December it would not fund a new eye hospital to replace the Princess Alexandra Eye Pavilion and proposed that services should instead be dispersed across the region, but First Minister Nicola Sturgeon then pledged during the election she would after all fund a new hospital if NHS Lothian wanted it. A cross-party group of MSPs is now pressing the government on the issue.

A study published in the Eye Journal looked at how referral patterns had changed since optometrists (opticians) were allowed to prescribe medicine ten years ago. Twenty-three per cent of Scottish optometrists now have the necessary qualification and can manage primary eye conditions.

The study found referrals by optometrists to GPs had fallen by 10.5 per cent, but referrals to hospital ophthalmologists had increased by 118 per cent and were still rising.

Dr Fleck said: “The hope had been they would take over some of the work done by ophthalmologists in the same way that pharmacists have taken over some of the work previously done by GPs, but in fact what has happened is a large increase in the number of referrals from optometrists to eye hospital services.”

He said the high referral rate suggested optometrists had uncovered unmet need, but were also less able to reach decisions than ophthalmologists.

“Doctors are trained to make best judgement calls and are able to make decisive choices that always involve a little bit of uncertainty whereas optometrists understandably are more likely and rightly not to want to risk that they have missed something or that something might be treatable now because of developments in the hospital. As a result the number of patients being referred to eye hospitals by optometrists has more than doubled.”

Dr Fleck said there were areas where care had already been devolved and was working well.

“For instance, when patients have had a cataract operation they don’t come back to the hospital for check-ups after surgery, they go to their optometrist.

“We’ve been ahead of the game for decades in Lothian, and Scotland is unique in the world in the very good close working relationship between ophthalmologists and optometrists and no-one wants to lose that.

“What doesn’t work is to suggest optometrists can replace ophthalmologists, especially in terms of patients coming with new problems.”

And he said running clinics in places like Haddington would be welcome if the necessary investment was made.

"When eye clinics are set up outside an eye hospital you have to have a core set of equipment which is very expensive and technical people to run the equipment and a team of staff. You can’t just have an ophthalmologist in an empty room and patients coming in to reading the eye chart.”

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