PACS+ Guidance on GOS18 module

When referring a patient with suspect glaucoma and a van Herick angle of grade 2 or less in either eye, clinicians will now be given the option to view the PACS plus referral guidance before making referral.

The guidance is as follows:

PACS-plus referral guidance

Primary Angle Closure Suspect (PACS) definition: limbal anterior chamber depth is <25% (van Herick grade 0 or 1), IOP is normal, no evidence of optic nerve damage or visual field loss.

When to refer PACS patients: Routine referral is only required if patient meets above definition PLUS at least one of the following criteria:

  •        People with only one ‘good’ eye
  •        Vulnerable adults who may not report ocular or visual symptoms
  •        Family history of significant angle closure disease
  •        High hypermetropia (> +6.00 dioptres)
  •        Diabetes or another condition necessitating regular pupil dilation
  •        Those using antidepressants or medication with a definite anticholinergic action
  •        People living in remote locations where rapid access to emergency ophthalmic care is not possible

PACS-minus:

If an individual has the angle-characteristics specified above but none of the above additional criteria and does not meet NICE glaucoma referral guidelines (based on IOP ≥24mm Hg or presence of signs of glaucoma) they should be advised to seek an annual examination.

References and further information:

https://www.college-optometrists.org/clinical-guidance/clinical-management-guidelines/primaryangleclosure_primaryangleclosureglaucoma_pa

https://www.rcophth.ac.uk/wp-content/uploads/2022/06/Management-of-Open-Angle-Closure-Glaucoma.pdf

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