Ophthalmology Patient Pathways

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The National Pathways can be downloaded from the links on the left.

Ophthalmology Introduction written by the development group:

The eyecare services in Scotland face increasing pressures as the aging population increases and the common eye disorders of the elderly require care. This particularly applies to the care of patients with cataract, glaucoma and age related macular degeneration. Good visual function enables independent and fulfilling lives and effective eyecare is important.

The pathways which have been developed are designed to facilitate optimal patient care with close collaboration between primary and secondary care and effective teamwork by all members of the eyecare team including optometrists, orthoptists, ophthalmic nurses and ophthalmologists. They have been developed by a multiprofessional group with regard to the available worldwide literature on the patient journey specific to eyecare, consensus opinion, peer review and lay opinion. Areas of care have been chosen which are considered to have significant impact on the service or are of clinical importance. 

One principle aim has been to optimise the expertise available in the community, particularly in optometry. In doing so it is recognised that the pathways depend on close collaboration between General Practitioners and Optometrists in the community and Nurses, Orthoptists and Ophthalmologists in secondary care.

The development group hopes the pathways will stimulate redesign of services locally. The pathways should not be seen as prescriptive but as a template to generate local discussion with the professionals currently delivering care in consultation with patients. It is inevitable that they will need to be modified and adapted to local needs.

In considering them local teams are asked to recognise the need to:

§   adapt pathways to the needs of the local community

§   ensure close communication (including IT links) between Optometrists, General Practitioners and hospital specialist services

§   pilot the pathways and audit the quality of the care received (i.e. audit clinical outcomes and the effective use of resources)

§   address training needs and continuing professional development of all staff

§   work in teams and not in isolation.

The pathways are likely to be more successful if they are proven to be both clinically and cost effective. They must reduce the number of patients being referred to secondary care and the number of steps in the patient journey. If the patients who can be safely managed in the community are, and there is a reduction in unnecessary visits to the hospital, this project will have succeeded.




A health professional trained to detect and correct refractive errors, to screen for eye disorders and prescribe treatment for some common eye conditions. Optometrists generally work in independent practice.


A health professional trained in the diagnosis and management of strabismus (squint), amblyopia (lazy eye) and double vision and other abnormalities of binocular vision. Orthoptists generally work closely with ophthalmologists in hospital clinics.


A doctor trained in the diagnosis and management of eye diseases and disorders of vision. Ophthalmologists generally work in hospital eye clinics and perform eye surgery.

Ophthalmic nurse:

A nurse who has developed particular skills in eyecare. Ophthalmic nurses work in hospital eye departments.

Glossary of terms used in pathways


Measurements made of the eye which are required to calculate the strength of the intraocular lens to be implanted after cataract removal.


A test of the patients peripheral vision. The peripheral field of vision is defective in glaucoma.


History and symptoms.


Intraocular pressure.


Optic nerve. In the glaucoma pathway

ON+ means optic disc signs typical of glaucoma

ON- means absence of these signs and a normal optic nerve appearance.


Posterior vitreous detachment.


Prism reflex test – one of the tests used in assessing binocular vision.



Ophthalmology Pathways Development Group

Dr Stuart Roxburgh   (Chair)

Consultant Ophthalmologist, Dundee

Professor P.A. Aspinall

Consultant Ophthalmologist, Edinburgh

M. Bell

Patient Representative

Mr Donald Cameron

Optometrist, Edinburgh

Dr Alan Clubb

GP, Musselburgh

Professor Bal Dhillon

Consultant Ophthalmologist, Edinburgh

Dr Robert Dickie

GP, Stornoway

Dr Ali El-Ghorr

CCI Project Manager

Ms Eva Frigola

CCI Project Leader

H. Glass

Patient Representative

Ms Barbara Grant

Ophthalmology Nurse Specialist, Dunfermline

Dr Jeffrey Jay

Consultant Ophthalmologist, Glasgow

Dr Veerababhu Maharajan

Consultant Ophthalmologist, Ayr

Ms Caroline McNabb

CCI Project Coordinator

Ms Hazel McWhinnie

Orthoptist, Area Head Orthoptist, NHS Ayrshire and Arran

Ms Yvonne Mitchell

Ophthalmology Nurse Specialist, Aberdeen

Mr Frank Munro

Vice President, Optometry Scotland

Mr Gordon Porteous

Ophthalmology Nurse Specialist, Aberdeen

Dr Roshini Sanders

Consultant Ophthalmologist, Dunfermline

Ms Lorraine Shields

Staff Nurse, Glasgow

Ms Anne Sinclair

Associate Specialist in Ophthalmology, Dunfermline

Ms Jennifer Stewart

Orthoptist, Perth

Mr Augusto Azuara-Blanco Consultant Ophthalmologist, Aberdeen (2008 update)

The evidence for these pathways was revised in 2007. The group reconvened and the AMD, Glaucoma and Flashers and Floaters slides were updated in February 2008.

The evidence base behind these Pathways is available.