Statement 1 Adults with signs of possible glaucoma or related conditions on a routine sight test have additional tests before they are referred for a diagnosis. [2011, updated 2019]
Statement 2 Adults with cataracts are not refused surgery based on visual acuity alone. [new 2019]
Statement 3 Adults with late age‑related macular degeneration (wet active) start treatment within 14 days of referral to the macular service. [new 2019]
Statement 4 Adults with late age‑related macular degeneration (wet active) have monitoring for both eyes. [new 2019]
Statement 5 Adults with chronic open angle glaucoma or related conditions have reassessment at specific intervals. [2011, updated 2019]
Statement 6 Adults with serious eye disorders are given a certificate of vision impairment as soon as they are eligible. [new 2019]
In 2019 the quality standard for glaucoma in adults (QS7) was updated and replaced by this new quality standard on serious eye disorders. Some statements from QS7 prioritised in 2011 were updated (2011, updated 2017). New statements (new 2019) were added on cataracts, AMD and support for people with vision impairment. For more information, see update information.
Statements from the 2011 quality standard for glaucoma in adults that are still supported by the evidence may still be useful at a local level:
People are referred to a consultant ophthalmologist for further assessment and definitive diagnosis if the optometrist or other healthcare professional suspects chronic open angle glaucoma (COAG). There are local agreements in place for referral refinement.
People with elevated intraocular pressure alone are referred to an appropriately qualified healthcare professional for further assessment on the basis of perceived risk of progression to COAG. There are agreements in place for repeat measures.
People with COAG, suspected COAG or with ocular hypertension (OHT) are diagnosed and have a management plan formulated by a suitably trained healthcare professional with competencies and experience in accordance with NICE guidance.
People with COAG, suspected COAG or with OHT have a regular review of management options with their healthcare professional, taking into account comorbidity and other changed circumstances, including a discussion of the benefits and risks of stopping treatment for those at low risk of progressing to visual impairment.
Healthcare professionals involved in the care of a person with COAG, suspected COAG or with OHT have appropriate documentation and records available at each clinical encounter in accordance with NICE guidance.
People with COAG who are progressing to loss of vision despite treatment or who present with advanced visual loss are offered surgery with pharmacological augmentation (MMC) as indicated and information on the risks and benefits associated with surgery.
People with COAG, suspected COAG or with OHT are given the opportunity to discuss their diagnosis, prognosis and management, and are provided with relevant and accessible information and advice at initial and subsequent visits in accordance with NICE guidance.
People with suspected COAG or with OHT who are not recommended for treatment are discharged from formal monitoring with a patient-held management plan and their discharge summary is sent to their GP and primary eye care professional.
The 2011 quality standard for glaucoma in adults is available as a pdf.
NICE has developed guidance and a quality standard on patient experience in adult NHS services (see the NICE Pathway on patient experience in adult NHS services), which should be considered alongside these quality statements.
Other quality standards that should be considered when commissioning or providing services for adults with serious eye disorders include NICE's quality standard for diabetes in pregnancy, which has a statement on referral for retinal assessment (statement 4).
A full list of NICE quality standards is available from the quality standards topic library.