Table 2.

Case histories

ID	Case history and detection pathway	Post-detection pathway to specialist glaucoma services
01	Detected on first ever visit to optometrist Noticing eyes watering and blurry when reading. Spontaneous decision to go to supermarket optometrist	Patient told by optometrist to phone eye clinic for an appointment 3 months from referral (patient phone call) to eye clinic appointment
02	Routine eye tests every 1–2 years. Wore glasses. Advanced normal tension glaucoma detected by ‘photograph’ at first visit to ‘new’ optometrist	Patient opted for private first consultation to minimise any opportunity for delay. Saw private consultant within 2 weeks. Commenced on ocular hypotensive therapy (Travoprost) and referred to specialist National Health Service eye clinic
03	Detected on first ever visit. Patient had not noticed anything was wrong. Supervisor at work noticed increasing frequency of mistakes at work, suggested eye test and booked an appointment	Got letter back from hospital eye clinic within 2 weeks of optometrist referral. Appointment was in 2 months’ time
04	Same optometrist for 8 or 9 years. Reporting severe headaches over eyes at last two appointments and problems with glare. Made GP appointment to discuss severity of symptoms GP referred patient to cataract clinic Glaucoma detected at cataract clinic	Cataract clinic appointment from GP took 4 months Cataract clinic initiated ocular hypotensive therapy and referred patient to glaucoma clinic (patient reports having to stay at cataract clinic for 3.5 h while they tried to reduce pressures)
05	Detected at first optometrist appointment	Patient unsure of exact timescale but ‘not long’
06	Been to optometrist since age of 8. Annual visit from age of 40 due to family history of glaucoma 1992: optic disc haemorrhage detected by optometrist. Patient reports no action taken by GP or two optometrists (second optometry opinion sought by patient due to family history) 1994–2003: optic nerve changes noted (increasing cup to disc ratio and between-eye asymmetry in 1999). Patient reporting pain in right eye+headaches+increasing problems with night and then all glare 2000–2002: reporting falls, difficulty crossing road, glare, accommodating to bright/dim light 2003: glaucoma detected by high street optometrist near to her place of work. Appointment made after patient broke her glasses in a fall Advanced glaucoma diagnosed at first appointment with consultant ophthalmologist	15 weeks between detection by optometrist and being seen at glaucoma clinic
07	Routine eye test every 2 years. Same optometrist for many years. He retired, glaucoma detected on next routine visit to his replacement	Attended hospital eye clinic within 2 days of seeing new optometrist
08	Referred to hospital with high pressures 30 years ago, attended eye clinic, but reports being discharged after a few visits. Routine sight tests every 2–3 years since then When glaucoma detected it was 3 years since last full eye check	Patient given letter to take to GP. Patient saw GP the next day Eye clinic phoned patient, 7 days after she saw GP, asking her to attend eye clinic the following week
09	Wore glasses for reading, but had not had an eye test for >10 years Started to notice things looked a different colour through one eye Optometrist referred patient to cataract clinic	Saw GP within 3 days of seeing optometrist Patient received letter from hospital with a ‘password’. Patient then had to ring hospital to make appointment Attended hospital appointment (at cataract clinic) within 2–3 weeks, but on first visit was told she was in the wrong place and ‘quickly’ referred her on to her current glaucoma specialist
10	Annual eye checks, cataracts and glaucoma detected at routine visit. Detected by an optometrist that patient had seen on previous appointments	Optometrist referred patient to GP (by letter) GP wrote to patient informing him that an appointment had been made at the hospital. Attended hospital appointment approximately 2 months later
11	Detected at annual eye check With hindsight patient reports pain above the eyes at night (throbbing) for 1 month prior to optometrist appointment, thought it was ear ache	Optometrist referred to GP. GP contacted the hospital Patient reports attending ophthalmology clinic the day after GP informed by optometrist. Given letter from optometrist/GP to take with her