Significant progress in the continuing roll-out of new ophthalmology services

“Significant progress” is being made in the ongoing reconfiguration of ophthalmology services across the country through the HSE Clinical Programme for Ophthalmology, and the integrated eye care team model.

Speaking to the Medical Independent (MI) at the Irish College of Ophthalmologists (ICO) 2023 Annual Conference, Prof William Power, HSE Clinical Lead for Ophthalmology, confirmed that the HSE has invested substantially in addressing ophthalmology waiting lists through dedicated clinical pathway funding, which is increasing dedicated ophthalmology theatre capacity and moving some services into the community.

“We are ahead of some of the other medical specialties in that regards; the cataract pathway was identified, medical retina, and paediatrics. So in the three Dublin CHOs [Community Health Organisations], despite the impact of Covid-19, they have essentially eliminated or reduced down to ‘normal’ levels the waiting lists for paediatrics in the community. In some of them they are now actually taking children from the waiting lists in Crumlin and we are trying to do that nationally.”

There is also HSE funding for community adult ophthalmology services in CHO 6, 7, and 9 to work on the cataract pathway, he said. “So people who are long waiters for cataracts can be sifted out of the hospitals and seen in the primary care centre, and if they need surgery, get their pre-op work done in the centre, get their surgery done as a day case [in the hospital], and then have their follow-up back in the primary care centre again. They have started implementing that in CHO 6…. The Dublin CHOs are a bit ahead, and some are moving to bigger facilities.”

The roll-out of dedicated cataract theatres across the country is also continuing, Prof Power confirmed. This follows the success of the roll-outs in the Royal Victoria Eye and Ear Hospital (RVEEH), Dublin, and Nenagh General Hospital (from University Hospital Limerick). Work is ongoing to open a second new dedicated ophthalmology/cataract theatre in the South Infirmary Victoria University Hospital in Cork as part of the transfer of services from Cork University Hospital. In addition, a new cataract theatre in the Mater Misericordiae University Hospital, Dublin, has just opened, and a second dedicated cataract theatre is due to shortly open in the RVEEH, with work also taking place in University Hospital Waterford (UHW) on a dedicated theatre.

The next plan is to introduce a national ophthalmology electronic medical record (EMR), which would fully link up the hospital sites and integrated eye care teams in the community, Prof Power revealed. “We are at the stage with vendors about to give us demonstrations and then tenders will go out…. It is difficult as we are linking voluntary hospitals and HSE hospitals, and there is a heightened awareness/fear about cyber security now so that is an issue. And trying to integrate the EMR with the administration and patient booking systems [will also be challenging].”

Meanwhile, also speaking to MI, outgoing ICO President Mr Tim Fulcher said the conference had been a great success. Over 200 ophthalmologists gathered for the three-day scientific conference at the Great Southern, Killarney, to hear the latest clinical developments in the specialty from eye experts at home and abroad.

“The quality of the talks, both from the international and local speakers, was fantastic. The trainee presentations were excellent as always. The symposia were very well balanced – there was something for everybody,” Mr Fulcher said. Clinical symposia at this year’s conference focused on medical retina, ocular tumours, keratitis, and the assessment and management of watery eye.   

The conference also heard about the ongoing changes to the delivery of eye care services, though the recent redevelopment of the medical ophthalmologist role and the roll-out of the integrated eye care teams. “I think it is very topical as service delivery is very much changing, and it needs to change,” Mr Fulcher commented. “I think everyone acknowledges that, and it is exciting to see all the primary eye care teams that are being rolled out. Obviously, there are challenges in setting up the training programmes, particularly on the medical programme, to ensure we have enough trainees to fulfil the future posts that we anticipate, but a lot of work is ongoing on that. The [European Society of Ophthalmology] Lecture was fantastic. It gave a really good personal journey account from the old medical ophthalmology service delivery through to the new, which is more involved in the whole team including allied health professionals, optometrists, orthoptists, nurses, supported by admin; and also the integration between community care and the hospitals to allow patients ultimately to be transferred and cared for in a more timely way.”

Mr John Doris, Consultant Ophthalmic Surgeon, UHW, was inaugurated as the new ICO President during the conference.