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Independents in England, Wales and Northern Ireland should keep an eye on what is going on in Scotland, writes Kathy Oxtoby…

The eye care category is of growing importance to pharmacists, who can provide convenient, easily accessible advice and support for their patients.

In Scotland, pharmacies are preparing for a big increase in the volume of eye treatment prescriptions.

This August saw the introduction of new arrangements for community optometry prescribing under General Ophthalmic Services, "which may affect the volume and nature of prescriptions" pharmacists in Scotland receive, says Community Pharmacy Scotland (CPS).

In a letter to pharmacy contractors, Scotland’s chief pharmaceutical officer professor Alison Strath "outlined that independent prescribing optometrists will now be able to issue Stage 2 treatment prescriptions, which can be dispensed in community pharmacies", says CPS.

Rise in prescriptions written by independent prescriber optometrists

Professor Strath said the new arrangements are “expected to see an increase in the number of prescriptions written by independent prescriber community optometrists and presented for dispensing in community pharmacies”.

She suggested pharmacies keep their stock levels for Stage 2 treatments, which have been indicated for nine conditions, “under review”.

There is no specific date for when the increase in prescriptions will come into effect.

The treatments, outlined in her letter include topical steroids, topical cycloplegics, alternative topical antibiotics, oral antibiotics, topical and oral NSAIDs, topical and oral anti-virals, systemic anti-viral drugs, topical lubricants, alternative topical anti-allergy drugs and alternative oral antihistamines.

The nine conditions are: anterior uveitis, anterior and posterior blepharitis, episcleritis, herpes simplex keratitis, herpes zoster ophthalmicus, infective conjunctivitis, marginal keratitis, ocular allergy and ocular rosacea.

CPS says pharmacy teams are “encouraged to familiarise themselves with the updated processes and prepare for possible changes in patient interactions relating to eye care”.

CPS says pharmacists may notice an increase in the volume of eye-related prescriptions, new types of prescriptions being presented (Stage 2 treatments), and more clinical interactions with patients related to eye care.

“Community Pharmacy Scotland sees the recent changes to prescribing arrangements in General Ophthalmic Services as a positive development,” said a spokesperson from CPS.

“As part of the changes, independent prescribing optometrists will be able to issue Stage 2 treatment prescriptions, which can be dispensed in community pharmacies. These Stage 2 treatments refer to a higher level of clinical management of eye conditions.

“While this change is expected to result in an increase in these prescriptions being presented for dispensing, community pharmacies are continually adapting to the development of new and existing services, and will do so in the delivery of this change.

“In addition, at a local level, community pharmacies and optometrists have established relationships and will continue to work in a collaborative way to deliver this service effectively, supporting improved care to patients in their local communities,” said the CPS spokesperson.

The new NHS Scotland optometry prescribing service is designed to support the management of more complex conditions within community optometry, instead of patients needing to be referred to hospital.

Gareth Jones, director of corporate affairs at the National Pharmacy Association, says: “It’s good news that patients in Scotland can receive treatment for conditions that would otherwise see them visiting their hospital.

“Pharmacists are highly trained professionals who with the right support can provide first class care to patients for minor ailments and conditions.”

Mohsin Mian, a pharmacist and director at KinWell Pharmacy in Nairn in the Scottish Highlands, says pharmacists in Scotland can expect to see “a lot more prescriptions coming through from optometrists who are independent prescribers”.

He is looking to increase the pharmacy's stock of steroid, non-steroidal, and antibiotic eye drops to allow patients to receive treatment on the same day. “It’s about ensuring that we have enough stock for these patients, as well as those on regular eye medication,” he says.

He advises: “If ​a pharmacist ​needs to query a​n eye treatment prescription, they should contact the optometrist to seek their opinion.”

Pharmacy is increasingly the first point of call for patients with minor eye ailments. “Patients ask pharmacists for advice on issues to do with their eyes, which could, for example, be about an infection, eye redness or runny eyes, or treatment such as antibiotic eye drops,” says Lila Thakerar, the superintendent pharmacist at Shaftesbury Pharmacy in Harrow.

Treatment of eye conditions will depend on a thorough review by the pharmacist, and includes different options, says Gurvinder Najran, lead pharmacist at The Greens Health Centre in Dudley, who also teaches pharmacy undergraduates at Keele University.

Blepharitis, an eyelid infection, can be managed through proper hygiene, providing there are no red flag symptoms, such as eye pain, change or loss in vision – patients with these symptoms should be referred for an urgent GP appointment or if appropriate to an urgent eye care centre, says Mr Najran.

Patients are advised to soak a clean flannel or cotton wool in warm water and place it on their closed eyelid for 5 to 10 minutes. They should then massage their eyelids for about 30 seconds, then clean them with cotton wool or a cotton bud, using diluted baby shampoo if desired. This routine should be performed twice daily, even after symptoms improve, he says.

Pharmacists can recommend suitable eye pads and wipes. According to Mr Najran, if symptoms persist, topical chloramphenicol eye ointment may be advised, (to be prescribed by the GP, as currently this treatment is not licensed over-the-counter for this indication). 

For a ‘red eye’ – red, irritated and bloodshot eyes – pharmacists can offer advice about eye hygiene, and also lifestyle advice, such as avoiding irritants like smoke, dust and pollen, and wearing eye protection if necessary. And artificial tear therapy can be used for dry eyes, he says.

For patients with conjunctivitis, pharmacists can offer them antibiotic eye drops or ointments, which can be sold over-the-counter, says Ms Thakerar.

For hay fever, antihistamine eye drops can help relieve eye itchiness and irritation, she says.

She recommends that when it comes to eye care, pharmacists stock “a competitive range” of tried and trusted products. “With eye treatment, people prefer a brand they have used before.”

She says Optrex “do a range of eye drops, including for red eyes, and hay fever”.

For patient choice and convenience pharmacists should stock eye products in different formulations, such as liquids and ointments, she says.

Some eye products will need to be kept in the fridge in the pharmacy and patients should be advised to keep these products refrigerated as well, says Ms Thakerar.

“However, a very convenient way of carrying eye preparations for infections is an eye ointment, which doesn't need to be kept in the fridge. And pharmacists need to advise patients of the expiry after one month of opening.”  

To help make the most of the eye care category, pharmacists could have a designated area just for eye treatments, says Mr Najran. Pharmacists could also promote eye treatments according to seasonal trends in eye conditions, such as antihistamine drops for allergic eyes during the summer months.

Mr Najran advises pharmacists to “ensure that the whole team has regular CPD updates on common eye conditions and are familiar with eye care products, and be aware of urgent local eye care services to refer patients where appropriate”.

“If we can demonstrate pharmacists are capable and happy to be managing and treating common eye conditions, this can support the case for them being added to the list of conditions for community pharmacy to treat as per the national advanced Pharmacy First service,” he says.

“This will support appropriate remuneration of community pharmacies and recognition that they can offer support for patients with minor eye conditions.”