COGS (Community Optometry Glaucoma Scheme) Annual Review – Formerly HOLOMS 

Who is this service for? COGS is a monitoring scheme for OHT (Ocular Hypertension) or stable glaucoma patients who have been discharged with a management plan from HES. To be discharged, the patient must have been given re-referral criteria and a frequency of review period on their management plan. 

What is a discharge management plan? When a patient is discharged from HES, they will be issued with a discharge management plan and a copy of their visual fields and OCT (if necessary). On the management plan, there will be criteria for re-referral into the HES – for example, if the patients' IOP is 26mmHg with GAT.  At this point, the patient should be re-referred to secondary care. 

Who can perform a COGS examination? Any optometrist with the Professional Certificate in Glaucoma, or an Optometrist enrolled on a Prof Cert Glaucoma course, and actively studying. NB: A pre-registration optometrist may also perform this service under the direct supervision of an optometrist with the appropriate qualifications. 

What must a COGS appointment consist of?

• History and Symptoms (To include medical history and compliance with any drops)

• Visual acuity

• Assessment of IOP by applanation tonometry 

• Anterior segment examination with slit lamp BIO

• Van Herrick peripheral anterior chamber depth assessment (Or OCT if available)

• Dilated fundus examination with slit lamp BIO  

• Standard automated perimetry – Central threshold (Supra-threshold for OHT/suspect glaucoma IF the field is normal) 

• Imaging 

What must be done after the appointment? Following a COGS appointment, the episode will need to be logged on to Pharmaoutcomes under the “COGS Annual Review/HOLOMS” section. 

• Upload PDF copies of the visual field plot and OCT reports 

• If an optometrist is referring to HES due to a change in outcome (e.g., a progression in the patient’s glaucoma) then a referral will be automatically sent to the hospital if selected on Pharmaoutcomes. 

• If the patient needs to be referred for any other reason, a separate referral outside of Pharmaoutcomes should be created and submitted as appropriate. Referring to HES under the COGS/HOLOMS should only be done if referring due to OHT/glaucoma progression. 

COGS Enhanced Case Finding (Formerly GRR – Glaucoma referral refinement) 

Who is this service for? This service is done at the request of an optometrist following a sight test where repeated measures are required. For example, raised IOP (>24mmHg), a suspect visual field or structural changes to the ONH. 

Who can perform a COGS Enhanced Case Finding appointment? Any Optometrist with a WOPEC Glaucoma Certificate. NB: A pre-registration optometrist may also perform this service under the direct supervision of an optometrist with the appropriate qualifications.

What must a COGS Enhanced Case Finding appointment consist of?

• IOP measurement with applanation tonometry

• Dilated slit-lamp BIO assessment of the ONH

• Full threshold visual fields assessment 

• Van Herricks peripheral anterior chamber depth assessment 

What must be done after the appointment? Following on from a COGS Enhanced Case Finding appointment, the episode will need to be logged on to Pharmaoutcomes under the “COGS Enhanced Case Finding” section. 

• Pick the urgency for the referral (Urgent, routine or No referral needed)

• Submit the findings of the appointment in the appropriate boxes 

• Attach the visual field plot and any scans taken (e.g., OCT) to complement the referral.