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New study to improve referrals for patients with nerve swelling at the back of the eye

Generic illustration showing the optic nerve in the eye.

Press release issued: 17 February 2023

Guidelines to speed up the diagnosis and treatment of patients with nerve swelling at the back of the eye, known as papilloedema, are being developed by researchers at the University of Bristol.

Papilloedema is caused by increased pressure inside the head and could be the first sign of a brain tumour. As 50% of people with a brain tumour have no symptoms, optometrists - eye care professionals who are trained to spot abnormalities and work at opticians - may be the first to notice a problem.

Optometrists often refer many people to hospital because the test results aren’t clear or they’re not sure how to interpret them.

It can be hard to tell if someone has nerve swelling because there are many normal variations in how healthy nerves look that can be mistaken for swelling. Special types of imaging can help diagnose nerve swelling. In the past, imaging tests were only used in hospital eye departments, but now many optometrists have them. 

The National Institute for Health and Care Research (NIHR) funded ‘Improving the Diagnostic accuracy of referrals for Papilloedema’ (DIPP) Study aims to address these problems by developing and evaluating a set of guidelines for GPs and optometrists to improve the accuracy of diagnostic referrals.

The study has three stages. The first will find out how optometrists and hospitals in different areas in England manage people who may have eye nerve swelling, and look at what training, equipment or resources might help. The second will involve developing guidelines for GPs and optometrists and information leaflets for patients. The third will evaluate how the guidelines are used and whether patient experiences have improved as a result.

Dr Denize Atan, lead of the Eye and Brain group at Bristol Medical School: Translational Health Sciences (THS), Clinical Lead of the Neuro-ophthalmology service at Bristol Eye Hospital, and co-lead of the study, said: “Currently more people with suspected nerve swelling are being referred, which means that people who really do have nerve swelling may be waiting longer for appointments.

“We hope the DIPP Study will help educate and guide GPs, optometrists and hospital doctors to work better together to improve the care and experiences of patients in the NHS.”

Dr Alyson Huntley, Senior Research Fellow and co-lead of the study based at the Centre for Academic Primary Care at the University of Bristol, added: “The strength of the DIPP study is that we are taking an integrated approach involving health professionals and the public across the eye care pathway. We are also looking at the situation nationally to provide recommendations for service improvement across England.”

In 2016, referrals of people with suspected nerve swelling significantly increased in Bristol, which researchers think may be due to the heightened cautiousness of community health professionals following the gross negligence manslaughter conviction (which was later quashed on appeal) of an optometrist for not identifying papilloedema in a child who later died. 

The first findings from the study are expected in 2023.

Further information

This study is funded by the National Institute for Health and Care Research (NIHR) School for Primary Care Research (project reference 581). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

About the Centre for Academic Primary Care

The Centre for Academic Primary Care (CAPC) at the University of Bristol is a leading centre for primary care research in the UK, one of nine forming the NIHR School for Primary Care Research. It sits within Bristol Medical School, an internationally recognised centre of excellence for population health research and teaching. Follow on Twitter: @capcbristol

About the NIHR

The mission of the National Institute for Health and Care Research (NIHR) is to improve the health and wealth of the nation through research. We do this by:

  • Funding high quality, timely research that benefits the NHS, public health and social care;
  • Investing in world-class expertise, facilities and a skilled delivery workforce to translate discoveries into improved treatments and services;
  • Partnering with patients, service users, carers and communities, improving the relevance, quality and impact of our research;
  • Attracting, training and supporting the best researchers to tackle complex health and social care challenges;
  • Collaborating with other public funders, charities and industry to help shape a cohesive and globally competitive research system;
  • Funding applied global health research and training to meet the needs of the poorest people in low and middle income countries.

NIHR is funded by the Department of Health and Social Care. Its work in low and middle income countries is principally funded through UK Aid from the UK government.

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