Patient satisfaction in the Peterborough community specialist optometrist in glaucoma shared-care scheme

Abstract

Conclusions Our data suggest that the DSAEK stroma may have a causative role in generating immune responses, that is, rejections seem to be favored by graft proximity to the AC angle. It may contribute to the migration of donor-derived antigen presenting cells (APCs) into the recipient's lymphatics (direct pathway). Alternatively, access to the graft of recipient APCs may be promoted by decentered graft positioning (indirect pathway). Interestingly, cells infiltrating the anterior chamber (AC) belong to the innate immune system: the cellular infiltrate contains mainly monocytes and cells differentiating into APCs, that is, mainly macrophages. 6 These cells can also be found in the cornea-but as an intact Descemet membrane does not allow any cellular transmigration, it is widely believed, that cells in AC are recruited through iris vessels and ciliary body in the context of a breakdown of the immune privilege. Cells in the corneal stroma (eg, after DSAEK) or the exchange of allo-antigens through APCs coming from the AC and/or the AC angle (especially after DMEK, where there are no donor stromal APCs present) consequently must be crucial for the generation of an immune response. In summary, the data may indicate an active role of donor-derived immune cells in the rejection process. Major limitation of our work is the size of the cohort; the importance of graft centration in DSAEK to minimize the risk for graft rejection therefore needs to be confirmed in a larger clinical setting.

An analysis of glaucoma repeat measures assessment results: Are core competencies enough?

“…More specifically within secondary care, competencies required by HCPs to undertake ‘expanded roles’ were set out in the Ophthalmic Common Clinical Competency Framework 11 . Such enhanced pathways are now commonplace, 12 and evidence confirms their popularity with practitioners, patients and commissioners 13–15 …”

“…11 Such enhanced pathways are now commonplace, 12 and evidence confirms their popularity with practitioners, patients and commissioners. [13][14][15] These innovations in glaucoma service delivery have stimulated the development of postgraduate specialist glaucoma training for optometrists ranging from simple competency validation programmes to The College of Optometrists (UK) professional higher qualifications at certificate, higher certificate and diploma levels. 6,16 Despite continued uptake of such training, 17 opinion pieces in the optical press have highlighted a debate that questions the need for optometrists to obtain any additional validation, noting that many competencies required for these qualifications already exist within optometric core competencies at registration.…”

“…11 Such enhanced pathways are now commonplace, 12 and evidence confirms their popularity with practitioners, patients and commissioners. 13 , 14 , 15 …”