Could opticians refer patients with suspected brain tumours?

For many of us, an optician is someone we rely on to test our eyes and to help us buy a new pair of glasses or contact lenses.

But what if they could also help spot the early signs and symptoms of benign tumours and rare types of cancer, and refer the patient directly to specialists?

The number of people diagnosed with brain, other central nervous system (CNS) and intracranial tumours is low, making up 3 in 100 new cases of cancer diagnosed each year in the UK. But despite being rare, the number of people being diagnosed with these tumours in the UK has increased by almost a third since the early 1990s, mostly in the over 60s.

Opticians have the skills, knowledge and equipment to identify warning signs of possible brain or CNS tumours, such as pituitary tumours.

Back in 2015, South Tees NHS Foundation Trust in the north east of England became the first NHS trust to test if opticians could play a role in spotting brain tumours earlier. The approach could also help identify patients who’ve had a suspected stroke, or are at risk of a stroke.

Supported by the ACE Programme, a joint NHS England, Cancer Research UK and Macmillan Cancer Support initiative in England, the Trust developed a new way for opticians to refer people directly to the neuroscience department at their local hospital for rapid diagnostic tests and treatment.

And the speed with which one patient was treated suggests this is worth exploring further.

Back and forth for patients

If you experience a problem with your eyes, you might go to your GP or a local optician. Of the two, the optician is ideally placed to assess any issues with your eyes and vision. Many GPs acknowledge this, and will refer people to an optician for a review of their symptoms.

But if the optician were to spot something in need of further investigation by a hospital specialist, you’d normally have to go back to your GP for a referral.

The GP would then send you to a clinic that deals with eye problems, before being referred to the neuroscience department at the hospital for brain tests if necessary.

This causes unnecessary steps and delays for people who, if any serious condition is causing the eye problems, may need urgent treatment.

Benefits to patients, primary care and secondary care

Janine Skeen had an appointment with her local optician after experiencing a loss of vision in one eye. Recognising this as a serious symptom, Janine’s optician referred her to Professor Phil Kane, a neurosurgeon at James Cook University Hospital in Middlesbrough. After having scans which showed two brain haemorrhages and receiving medication for limiting swelling, Janine was diagnosed with glioblastoma, the most common form of brain tumour, and was operated on the following week.

“I’d started bumping into things a lot and getting confused so I went to see my GP who sent me off for blood tests,” says Janine. “The tests all came back fine but my mum was sure something wasn’t quite right and that I needed glasses so she convinced me to make an appointment with the optician.

“The optician examined me and said he was going to refer me to hospital.

“The next week I had an operation lasting several hours to remove as much of the tumour as possible.”

85% of patients in England are expected to start treatment within 62 days of an urgent referral for suspected cancer. And Janine had been operated on just 8 days after seeing her optician.

Janine’s case highlights the success and straightforward referral pathway that we as optometrists can now use

– Naseer Mohammed, optician

Because of this, Professor Kane is convinced the direct referral from the optician offers a faster alternative for diagnosing and treating the small number of brain tumours it might pick up.

“This case study is an example of the way we should be doing things,” he says. “Where things are obvious, we should be able to respond rapidly.”

This more direct approach could minimise the time it would take to be referred from the GP to hospital, benefitting patients by improving their experience and potentially their outcomes too.

And for patients with red-flag symptoms such as change in field of vision, this more direct route to specialists could mean faster diagnosis and treatment.

Naseer Mohammed, Janine’s optician and ophthalmic director of Specsavers Middlesbrough, says the direct route shows how his skills can be used more effectively to potentially help save lives.

“Most patients visit their GP for eye related problems rather than their optometrists as first choice,” he says. “Janine’s case highlights the success and straightforward referral pathway that we as optometrists can now use.”

If the approach holds up to testing across larger areas, Mohammed believes it could save lives as well as sight.

Crucially, Kane is confident that the approach won’t also put extra strain on stretched diagnostic services. That’s because the piloted approach only includes people with red flag symptoms who you’d expect would arrive at a specialist via their GP anyway.

This approach isn’t about sending more people for tests, it’s about trying to find a way to get those who need tests to a specialist sooner.

A UK first

The project in South Tees is thought to be the first of its kind in the UK. Data were collected for a year, and the results are encouraging.

Janine was the only person diagnosed with cancer of the 15 people who were referred by a small group of opticians during the 12 month pilot, though all patients benefitted from seeing specialists quickly or receiving the all clear. Imaging tests on some of these patients discovered early signs of a stroke, or risk of having one.

The project also brought together GPs, opticians and neuroscience colleagues who had not previously worked together. According to those involved, this has helped build collaborations for the future.

“The most heartening thing for me was that the project started breaking down some of the professional barriers that exist and generated a much greater enthusiasm to look at how we can work more collaboratively with opticians,” says Kane.

As with all new approaches, this will need to be tested across a wider area to know how effective it is in more people.

But based on the potential for swift treatment, we may soon see the role of opticians through a slightly different lens.

Edmund Fuller is an engagement and communications officer at Cancer Research UK

• Visit the ACE programme website for the results of more projects and further information.