What is ACES?

A same/next-day community eye care service for acute eye problems, designed to:

• Manage urgent conditions in practice

• Reduce unnecessary hospital referrals

• Support GPs with specialist assessment

Who is it for?

Eligible patients:

Registered with a Somerset (or eligible Devon) GP presenting with recent (usually ≤7 days) acute symptoms

Access

• Self-referral or GP referral

• If you can’t see them → redirect to another ACES provider

What must you do?

Core assessment (ALL patients):

• History & symptoms

• Visual acuity

• Slit lamp exam

• Pupil reactions

• Record everything on Pharma

Additional tests (as needed):

1. IOP

2. Dilated fundus exam (Volk)

3. Visual fields

4. Amsler

5. Motility / binocular vision

Key Clinical Scenarios

Flashes & Floaters

• Dilated binocular fundus exam (Volk)

• Document: PVD / Weiss ring, “Tobacco dust” & check IOP

Red Eye

• Full anterior segment exam

• Use fluorescein staining

• Differentiate: Bacterial / viral / allergic

• Scleritis / episcleritis

Foreign Body

• Lid eversion (incl. double if needed)

• Record removal method (e.g. needle, burr)

Suspected Acute Glaucoma

• Check IOP + anterior chamber depth

• Look for corneal oedema / iris bombe

Equipment Required

• Slit lamp

• Tonometer

• Visual fields analyser

• Volk lens

• Diagnostic drugs (drops, stains)

• Foreign body removal tools

Accreditation & Training

Must complete ICB-approved training

Includes:

• Acute eye conditions

• Differential diagnosis

• Volk skills + FB removal

• Re-accredit every 3 years

• Annual peer review required

Your Responsibilities

• Complete Pharma record (mandatory for payment)

• Obtain patient consent

• Send records: GP (within 24h or immediately if Rx needed)

• Provide patient advice + leaflets

• Participate in audit & governance

Important Rules

• No GOS sight test at same visit

• No payment for DNAs

• Not for chronic conditions

• Must follow infection control + governance standards

Why ACES Matters

• ~2 million people affected by sight loss in the UK

• Demand rising significantly

ACES:

• Improves access to urgent care

• Keeps patients out of hospital

• Uses optometrist expertise effectively

Download Contract

ACES Pathway

Find a participating practice

What is this service?

A community-based pathway to repeat and refine intra-ocular pressure (IOP) measurements to:

• Reduce unnecessary hospital referrals

• Improve glaucoma detection accuracy

• Provide faster patient care locally

Who is it for?

Adults 18+ registered with a Somerset GP with:

Mean IOP ≥ 24 mmHg (NCT)

Not suitable for:

• IOP <24 mmHg

• IOP ≥32 mmHg (bypass service → refer)

• Known glaucoma patients under HES

• Suspicious optic discs or visual fields

What does the service involve?

• Repeat IOP measurement using Goldmann Applanation Tonometry (GAT)

• Conducted by accredited practitioners in community practice

• Findings recorded on Pharma

Referral Pathway

Download Contract

Find a participating practice

What is this service?

A community monitoring pathway for patients with ocular hypertension (OHT) who have been:

• Diagnosed in Hospital Eye Services (HES) and discharged to community care with a management plan

Who is it for?

Eligible patients:

Adults registered with a Somerset GP diagnosed OHT with:

• IOP ≥24 mmHg

• No glaucomatous optic disc changes

• Normal visual fields

• Typically on treatment and at risk of visual impairment

Exceptions:

• Some untreated OHT patients (if HES specifies)

• Legacy patients (pre-2017 criteria)

Exclusions:

• Diagnosed glaucoma

• OHT patients not at risk of vision loss

• Symptomatic patients needing other pathways

What do you do at each visit?

Core clinical tests:

• Visual acuity

• Goldmann Applanation Tonometry (GAT)

• Van Herick’s

• Slit lamp + disc assessment (with dilation)

• Visual fields (24-2 or equivalent)

Download the OHT Patient Record Card (OPRC)

Download Contract

Find a participating practice

Low vision assessments in Somerset are provided by the Somerset Sight. For more information see the following documents.

Low Vision Leaflet

Somerset Sight: Can we help booklet

Somerset Sight Referral form

See also our support for sight loss section