The Eye Health Examination and Primary Eye Care Acute Referral Scheme (PEARS)
The Eye Health Examination and the Primary Eye Care Acute Referral Scheme (PEARS) are unique to Wales.
Purpose
Primary Eyecare Acute Referral Scheme - PEARS
The purpose of a PEARS examination is to address the needs of the patient presenting with an acute eye condition i.e. ocular symptoms which would require urgent, if not immediate, attention. The aim of the scheme is to maintain as many patients as possible in the Primary Eye Care setting, thus avoiding unnecessary referrals to HES departments. This means that optometrists will need to make good clinical judgements in practice and follow these judgements through sensibly.
Eye Health Examination
The Eye Health Examination enables optometrists to screen vulnerable patients who are more at risk of developing eye disease, or patients who would find the consequences of losing their sight particularly difficult. Early detection of eye disease in these groups is particularly important as patients may be asymptomatic.
Patient Criteria
PEARS
Any patient presenting with acute symptoms requiring attention can have a PEARS eye examination at no charge to the patient. The patient can self-refer for a PEARS eye examination or may be referred by their general practitioner.
Eye Health Examination
The following groups of patients are entitled to a free Eye Health Examination.
· Uniocular patients i.e. patients who would be significantly handicapped if they lost vision in their better eye.
· Patients who are profoundly deaf – these patients need sight to lip read.
· Patients with retinitis pigmentosa, or siblings of patients with inherited eye disease.
· Patients whose family origins are Black African, Black Caribbean, Indian, Pakistani or Bangladeshi.
· Those at risk of eye disease by reason of race or family history.
Patients may self-refer, or be referred by their general practitioner for the Eye Health Examination.
Procedures
PEARS
Optometrists must, within reason, be able to offer a PEARS examination on the same day or within 24 hours after the appointment has been requested by the patient or G.P.
For PEARS, the level of examination should be appropriate to the reason for referral. All procedures are at the discretion of the optometrist; however, the following guidelines should always be adhered to:
· The fundus examination must be through a dilated pupil
· Examination of the red eye must involve a slit lamp examination used in conjunction with a staining agent
· Visual field examination results must be in the form of a field plot rather than a written description.
· Glaucoma assessment must include a description of the optic nerve head, a visual field examination, applanation tonometry and an assessment of the anterior chamber angle.
· Symptoms of a sudden reduction in VA should be investigated by an examination of the macular using a Volk, or similar lens, and by recording the extent of the loss with an Amsler chart.
· Symptoms of a sudden onset of flashes and floaters should be investigated by an examination of the anterior vitreous and peripheral fundus with a Volk, or similar lens.
· Relative afferent pupil defect (RAPD) testing is essential.
· Other tests may be used as appropriate.
Eye Health
The following procedures are mandatory for the Eye Health examination.
· Visual acuity measurement.
· A dilated fundus examination using a slit lamp and a Volk lens.
· An assessment of the anterior angle.
· Contact tonometry using a Goldmann or Perkins tonometer.
· A visual field examination, from which a quantifiable field printout is available.
· A slit lamp examination of the anterior segment.
All other procedures are at the discretion of the examining optometrist.
Equipment
Equipment is the same for both the PEARS and the Eye Health examinations
The minimum level of equipment should include:
· Slit lamp
· Volk, or similar lens
· Contact tonometer (Goldmann or Perkins only)
· Visual field equipment capable of producing a field plot
· Eyelash removal instruments (Epilation capacity is essential)
· Ophthalmoscope
· Amsler charts
· Diagnostic drugs
Training
Accreditation training covers both the PEARS and Eye Health examinations. There is no separate training required for each type of examination. All optometrists are required to undergo accreditation; there are no exceptions.
To be accredited to carry out the Eye Health and the PEARS examinations each optometrist must undertake a two-part process. Part One comprises seven theoretical modules and multiple-choice questioning covering a range of subjects relevant to the WECI. Part Two involves a practical assessment exercise including evaluation of slit lamp biomicroscopy technique and contact tonometry. In order to progress to Part Two, the candidate must have successfully completed Part One of the process.
On-line training
Accreditation training for the theory (Part One) can be carried out using a written format or on-line at www.eyecarewales.org.
An optometrist wishing to undertake the accreditation for the PEARS and Eye Health Examinations, must first fill in a registration form. Registration forms can be obtained by contacting the appropriate Local Health Board or Business Service Centre. Registration forms ask for information about the optometric practice, including the level of equipment with regard to visual field equipment, contact tonometry and slit lamp biomicroscopy. Once the registration form has been completed and returned, the optometrists name will be added to a list of those awaiting accreditation training. Each optometrist will be contacted prior to the next available accreditation procedure. The accreditation is carried out by Cardiff University. For information about the accreditation, contact Dr N Sheen on 029 20876988.
Last updated:
06/04/2006
