Matheson Optometrists first became involved with providing enhanced services in the community in the late 1980’s fitting low vision aids and specialist contact lenses for local hospitals. Andrew Matheson started treating Dry Eye and fitting punctual plugs in the early 1990’s, having trained in America to gain these new skills. He passed the American Academy fellowship exams in 1996. Since that time he has held regular dry eye clinics in his group of Hampshire practices. His close links with American ophthalmologists and optometrists has helped him practice to the highest level in this field. He cares for patients from all over the UK and abroad. Andrew lectures and holds workshops on dry eye therapy to optometry students, qualified optometrists and GPs. Andrew wrote the script in the official College of Optometrists “Dry Eye Management” training DVD and demonstrated the techniques of fitting punctual plugs and intra-canalicular plugs on this DVD.
Matheson Optometrists is one of the pioneer 4 practices that helped set up the Queen Alexander Eye Hospital community Glaucoma Management Scheme approximately 15 years ago, to look after stable glaucoma patients in the community. At that time Matheson Optometrists was also part of the local community diabetic screening program. This was later disbanded when the private national group Care-UK took over diabetic screening in the area. The local Glaucoma scheme continues however and there are now 12 practices in the scheme. The initial scheme was set up by the hospital itself by its glaucoma specialists. It has now been taken over by the local commissioning body. Because Andrew is both an independent prescriber and also holds the College DipGlauc higher qualification he is able to intervene when these patients’ glaucoma ceases to be adequately controlled and change their medication accordingly. This saves the necessity of them being re-referred back to the hospital for this purpose. The scheme is a great success and is loved by the patients in it.
Another community glaucoma scheme run by the same CCG and Eye hospital is the Glaucoma Referral Refinement Scheme. This involves the same group of accredited optometrists as the GMS scheme, only this time GP glaucoma referrals instead of being sent straight to the Eye dept, are instead seen by an accredited optometrist who does applanation tonometry, Humphrey threshold visual fields, disc assessment and photography, Angle assessment, pachymetry and possibly OCT imaging and gonioscopy as required. These results are transferred electronically effectively giving the hospital a “Virtual Clinic” in the community. It has had a major effect on waiting lists with only 15-20% of the referred patients needing to be seen afterwards at the local eye department. We continue to provide these services if a patient becomes too infirm to visit the practice on a domiciliary basis.
Matheson Optometrists is also part of a community retinal imaging scheme in collaboration with local NHS consultants. Retinal photos and OCT scans are taken in their community practices reducing the need for the patient referred with a suspicious lesion to attend the hospital for investigation. One of their optometrists works in the local medical retina department one day a week. Fundus Auto-fluorescence images can also be taken and provided to the medical retina consultants via this virtual clinic arrangement.
A local commissioning group set up Low Vision Scheme providing Low Vision Aids closer to home for these visually disabled patients. Following the assessment, these aids are dispensed “on-loan” to the patient. Again this de-stresses the over-stretched hospital department and brings the services closer to the patients home. The Matheson group works closely with visual rehabilitation and low vision counselling services locally in cases where extra help is required. Although electronic magnifiers are not covered in the LCG scheme, they are dispensed regularly as are high performance daylight reading lights.
The Alresford and Four Marks Matheson Optometrists practices are involved in providing PEARS and PEARS-plus(glaucoma) services to the patients in the area served by the Basingstoke Eye Hospital. This is also well received and was set up approx. 12 months ago to allow GPs to refer acute eye problems to an accredited optometrist instead of being referred many miles to the Basingstoke hospital which is already inundated with too many patients.
Being a specialist therapeutic optometrist with glaucoma prescribing qualifications Andrew Matheson is registered with BUPA and other private insurers. This enables a close working relationship with local private specialists who refer their patients regularly for Dry Eye Assessment, Punctal Implants, OCT imaging, Retinal photography and visual fields among other services. For those not covered by private medicine the Matheson fees are much lower than at the local private hospitals and are welcomed by the surgeons patients. Again, results are usually transferred electronically so are available to the specialist immediately.
Because of his therapeutic qualifications Andrew has he is able to manage many acute eye presentations directly in practice. Examples of conditions that typically fall into this category are post-surgical cystoid macular oedema, anterior uveitis, corneal infections including Herpes Simplex and emergency treatment in acute glaucoma. In these situations the patients GP and eye specialist is kept informed of and interventions and appropriate onward referral implemented.
We often cater for emergency appointments such as patients with red eye, flashes and floaters and embedded forign body removal. Obviously prevention is preferable to intervention and as such we stroungly encourage the use of safety spectacles whilst working in any high risk enironment.
As the towns and villages that the Matheson Optometrists practices are located in are often 20 miles fro m the nearest over-stretched hospital eye department, providing these extended services in the community can be very beneficial for patient and hospital alike. In time perhaps we can help more?
