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Bevan Exemplar Cohort 5 Projects

Needle in a haystack: Finding the glaucoma patients that are going blind

Wai Siene Ng, James E Morgan, Gareth Bulpin and Sharon Beatty

Cardiff and Vale University Health Board


Glaucoma is one of the leading causes of blindness in the UK. The National Patient Safety Agency has highlighted the impact of delays to follow-up for patients with glaucoma and consequent risk of significant sight loss. The lack of capacity in clinical services to manage glaucoma only increases this risk. We propose a more radical model in which a technician-led service allows for rapidly reviewed new patients by specialists. All clinical data will be entered into the electronic patient record (OpenEyes) and reviewed by the consultant virtually. This format of referral refinement can massively impact on reducing new referral appointments as well as allow for the detection and fast-tracking of advanced glaucoma cases.

Project Aims:

  • We will focus on detecting and fast tracking the 10-15% of patients that are at significant risk of life-changing visual impairment
  • In addition to this, we aim to free up capacity by discharging those who don’t have glaucoma


  • Training of staff to perform clinical data measurements to the best standard possible to enable accurate virtual assessments
  • Training of clinicians and nursing staff on electronic patient record use
  • Gaining funding to scale-up virtual clinics

Key Outcomes:

317 new patients were seen in 3 months from 1st June 2020 – 30th September 2020

Next Steps:

  • Scaling up of virtual clinics with clinical data collection in more optometric practices
  • Complete collation and analysis of patient satisfaction surveys

Our Exemplar Experience:

I have enjoyed the connections and advise received through being put in touch with contacts within my health board especially finance. The various workshops were also very enlightening and helped with my journey in propagating change.



Wai Siene Ng: