Selective laser trabeculoplasty (SLT) performed by optometrists for patients with glaucoma and ocular hypertension: a scoping review

Abstract

Selective laser trabeculoplasty (SLT) has been established as an effective treatment to lower intraocular pressure in people with glaucoma and ocular hypertension. The procedure is typically within the remit of ophthalmologists; however, there is potential to upskill optometrists and other healthcare professionals (HCPs) to deliver the treatment. We conducted a scoping review to identify the current global landscape of HCP-delivered SLT and describe training features, clinical effectiveness and safety. Relevant articles were identified through online database searches and grey literature sources. Four articles were selected for full inclusion. This review identified training programmes for optometrist-delivered SLT in the UK and the USA. The findings indicate that more research is needed to clarify training requirements and clinical effectiveness.

Selective laser trabeculoplasty (SLT) performed by optometrists—enablers and barriers to a shift in service delivery

“…Clinicians expected the training to maintain the existing apprenticeship format [ 4 , 5 ]; optometrists would undergo theoretical clinical and laser safety training, followed by a period of observing, delivering SLT under supervision and then being signed off as competent. Chadwick et al [ 4 ] reported a minimum of five supervised procedures, similar to the Moorfields protocol for non-medical SLT training [ 24 ], but this was often exceeded, mainly due to a lack of adequate challenging cases or self-confidence [ 4 ]. In agreement with the literature, clinicians interviewed for this study identified that practical training should follow a skills based approach.…”

“…In agreement with the literature, clinicians interviewed for this study identified that practical training should follow a skills based approach. The current lack of training standardisation [ 3 , 4 , 24 ] may be linked to difficulties in ensuring an adequate case mix and the subsequent delay in clinical readiness.…”

“…Ophthalmologists in the UK are currently required to have performed 30 IOP-reducing procedures, including laser treatments, upon completion of training [ 28 ]; these may include SLT, peripheral iridotomy, argon laser trabeculoplasty, iridoplasty and cyclodiode, leading to a possible variability in the type of laser procedures and the number of cases amongst graduating ophthalmologists. Current optometrist training SLT protocols dictate the delivery of at least five SLT treatments under supervision [ 24 ] and there is no indication that, once gonioscopy and prescribing rights are mastered, optometrists’ SLT training needs are different to those of ophthalmologists. There are also no technical specifications on the training of ophthalmologists or optometrists in SLT; the Royal College of Ophthalmologists Ophthalmic Specialist Training guide states that trainees should be encouraged to practice on model eyes before performing common laser procedures, but the use of a sidearm or video slit lamp is only considered necessary for laser photocoagulation.…”

Ocular therapeutics and the profession of optometry in South Africa

“…14 , 19 This assertion is corroborated by a study in the UK, which found that optometrists trained in glaucoma management could potentially manage and treat patients with ocular hypertension in the community without a referral to an ophthalmologist. 20 , 21 Moreover, specially trained and accredited optometrists working independently within the hospital environment, monitoring glaucoma and glaucoma-suspected patients were seen to be capable of making clinical management decisions that were in close agreement with those of glaucoma-specialist consultant ophthalmologists. 20 Considering that patients with conditions such as ocular hypertension and glaucoma require lifelong management usually by an ophthalmologist, and often within an institution in the public sector, the comparatively lower numbers of ophthalmologists to optometrists worldwide serve as an impediment to the availability of safe, prompt and effective treatment.…”

Providing capacity in glaucoma care using trained and accredited optometrists: A qualitative evaluation

“…Optometrists provide significant capacity within glaucoma pathways, involving detection, diagnosis, monitoring and treatment [ 23 , 24 ]. Despite these contributions, there has been little qualitative research on whether care by optometrists is an accepted alternative to traditional-care, and what factors impact development and sustainability of glaucoma services with optometric involvement.…”