Glaucoma Repeat Readings module for Primary Care
Glaucoma Repeat Reading Service
If glaucoma referral filtering is available to the patient through local commissioning, then it should always be used, as described in NICE NG81.
Getting Started
- Log into Opera at app.optom-referrals.org. We recommend using the Microsoft Authenticator App for quick and easy access.
- Locate your patient using Manage Patients under the General menu:
You can use the search boxes to find a patient who is already on Opera, or use ‘Quick Patient Add’ to identify an entirely new patient from the NHS Patient Demographic Service
3. Select the turquoise ‘GRR’ icon against your patient’s name to start the Glaucoma Repeat Readings forms:
Glaucoma Repeat Readings Process
There are three stages to processing Glaucoma Repeat Reading on OPERA, although the first two are usually completed together and a Second Repeat is not always necessary:
Conducting the First Repeat immediately following sight test
The first applanation IOP should be conducted immediately after the sight test. If you decide that a second repeat applanation will be necessary, then establish the booking date for the return visit before starting the Opera process: you will need this information.
If only one applanation IOP is needed, then the first two stages can be completed straight away and this will conclude the episode. This should take no more than 2-3 minutes.
Stage 1:Log Pathway Entry
Page 1: Patient Demographics
Simply confirm you have the correct patient information and click Next.
Page 2: Policy Confirmation, Eligibility, and patient origin
The Policy Finder window shows which version of the GRR pathway is available to this patient. The policy type determines entry criteria and test protocols (one or two applanation measures and inclusion/exclusion of repeat visual fields). The service available to the patient depends on which NHS ICB their General Practitioner belongs to, not the location of your practice. You will usually recognise the pathway commissioned for your area, but practices in border locations may see variation.
Click to confirm that your patient is eligible under the criteria listed above.
Click to confirm if the patient was referred to your practice, or if they are your own.
Click Next.
Page 3: Phone number, Appointments Dates, Source of Referral, Consent
Enter the patient’s Preferred Contact Number.
Date and time of GRR First Appointment will often be the same as the Sight Test. The time will be used to date-stamp your first applanation IOP and may be clinically significant.
Source of Referral records if the patient had a GOS or private sight test or were referred from other sources such as a Single Point of Access or another optical practice.
Consent to Access Eye Records is required to complete the process.
Permission to View their Summary Care Record is optional but enables us to attach potentially useful information to a referral, should this be necessary.
Click Next
Page 4: Confirmation of booking and submission. Pathway Entry is complete.
Stage 2: Sight Test IOP/VF and First Repeat
Locate your patient episode under Manage Referrals
Click the yellow button labelled “GRR Appointment” to enter.
Page 1: Patient Demographics
Previously entered information is shown on the left of the screen
The patient’s demographics are shown on the right. Check these and click Next.
Page 2: Clinical Entry
- Enter Clinical details from the Sight Test
- Enter Clinical details from the GRR Examination
Note: The form is contextual and adjusts to local pathway requirements and user entries. For example, if repeat visual fields are commissioned and you indicate that the Sight Test VF was abnormal then additional fields will request VF results for the GRR examination.
Click Next
(Note: a common mistake is to enter the applanation IOPs into the Sight Test data boxes)
Page 3: Outcome and Submission
The Outcome Status automatically indicates the outcome of this stage of the process.
Enter the Date of next appointment and time.
Add Clinical signs, symptoms and observations.
Consider offering: Risk factors, VAs, Van Herick, CCT, Lens status, Disc description.
These will be included in any later referral documents.
If the patient journey is complete, then enter contact details for patient feedback (PROMS)
(You might explain that the service has saved them an unnecessary visit to hospital)
Click Submit
Stage 3: Second Repeat
Locate your patient episode under Manage Referrals (as above).
Click the yellow button labelled “GRR Appointment” to enter.
Page 1: Demographics (as above)
Page 2: Clinical Entry
Enter Clinical details from the second GRR Examination
Note: The form is contextual and will only record results required under the local pathway. For example, if IOP remains high then a second VF result will not be required because you will be proceeding to referral regardless.
Click Next
Page 3: Outcome and Submission
The Outcome Status automatically indicates the outcome of this stage of the process. In this example we are proceeding to referral.
Add Clinical signs, symptoms and observations.
Consider offering: Risk factors, VAs, CCT, Lens status, Disc description. These will be included in the referral documents. Enter refraction information – this is useful to HES colleagues.
Enter contact details for patient feedback (PROMS)
Click Submit
Conducting the First Repeat separate to the sight test
Sometimes immediate applanation is not possible, perhaps because the sight test optometrist is not accredited for the service and an intra-practice referral is required.
In these circumstances, Stage 1 of the process should be completed immediately to log the patient’s entry into the GRR pathway and record the planned appointment date.
This does not require any clinical data entry and can be completed by an admin user.
When the patient returns for their first repeat measurement, the episode will be ready on Opera for clinical entry of the first repeat measurement.
Processing a Referral
Precise mechanisms may vary according to local systems and protocols. What follows is the method for conducting a referral from within the Opera platform.
The GRR episode will have concluded with an outcome to refer to HES.
The episode status tab will be red, indicating an action must be processed.
Locate your patient episode under Manage Referrals (as above).
Click the red button labelled “Routine HES Referral” to enter the referral process.
Page 1: Patient Demographics
Confirm Patient details and click the right arrow (top right) to proceed.
Page 2: Secondary Care Provider Filters
Select the necessary categories, e.g. Ophthalmology, Routine, Glaucoma.
Click the blue right arrow.
Page 3: Select Provider
Choose the patient’s preferred provider from the available list. Click the blue right arrow.
Page 4: Add Attachments
Add Visual Field plots. Files can be selected in the pop-up window or dragged & dropped.
You may include fundus photos or OCT scans if you wish (although not required or funded).
Click the blur right arrow.
Page 5: Final Confirmation and Submission
Once submitted the referral will be electronically transmitted and cannot be changed.