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NICE and joint‐College guidelines on the referral of glaucoma suspects

Dear Editor-in-Chief, I would like to comment on Khan et al.’s very interesting paper in November’s Ophthalmic and Physiological Optics. The paper discusses the impact of the National Institute of Health and Clinical Excellence’s (NICE) guidelines on referrals to the hospital eye service, but incorrectly states that NICE recommend using Goldmann applanation tonometry (GAT) when referring a patient. This is a common misconception. The NICE guidelines do not cover referrals, but they do recommend GAT when a diagnosis is made. It is for this reason that the College of Optometrists and the Royal College of Ophthalmologists published some guidance on the referral of glaucoma suspects by community optometrists in December 2010. These guidelines state that ‘When referring a patient on IOP grounds alone, GAT (or Perkins tonometry) is regarded as offering greater accuracy’. NICE have since published a Quality Standard (QS7) for glaucoma. This references the joint Colleges’ guidance and also includes a case study on the benefits of a repeat measurement (IOP and visual fields) scheme to avoid unnecessary referral for glaucoma. A scheme to do this has previously been reported in this journal.