Emergency eye care in the UK: the way forward?
Reviewed by Sofia Rokerya

In this paper the authors highlight issues pertaining to the growing number of patients presenting to the emergency eye services in the UK. Data collection involved literature review, telephone surveys and email correspondence (n=142). Ninety-one lead clinicians responded and a total of 50 semi-structured interviews were completed (January to June 2016), representing 35% of UK eye departments. Rising numbers of patients were reported by every consultant who had a greater than five-year emergency attendance data. It was indicated that a capacity-demand disequilibrium exists in the service. Contributors were an increase in life expectancy, reduced out-of-hours access to GP portals, a paradigm shift in health-seeking behaviour of the attendees and the ophthalmic de-skilling of main A&E under a four-hour target pressure. Capacity reduction has been attributed to reduced trainee numbers, less confident clinicians seeing patients more slowly, with frequent follow-up amalgamated with added tests and treatments performed due to medical advancement. Recommended measures for capacity expansion and demand management include computer triage tools. It is suggested that patients and practitioners could be empowered by engaging with training programmes, such as the Scottish ‘Teach and Treat’ centres, or other triage tools to prevent low-value attendances. Suitably experienced healthcare professionals, specialist nurse practitioners and optometrists could be engaged to play a beneficial role in triaging. However, the authors felt that the role of a community optometrist model in the eye care pathway remained yet to be evaluated as a cost-effective strategy. It is anticipated that the traditional pattern of eye casualty departments being staffed by the least experienced trainees is expected to shift and consultant-led multidisciplinary team (MDT) services in Emergency Eye Care will be the future. 

The urgent need to develop emergency EYE care in the UK: the way forward?
Buchan JC, Barnes B, Cassels-Brown A, et al.
EYE
2017;31:1515-8.