How do I get a free six-monthly eye test on the NHS if I have GCA?

[Trenny]

On a recent post someone said that the NHS allowed free six-monthly eye tests if one had GCA. Specsavers was mentioned as being aware of this. I 'phoned my local Specsavers to make an appointment and was told that I had to wait until my next test was due, a year after my last one. They refused to investigate further. Has anyone any further information on this?

[PMRpro Ambassador]

Having had a close look at the Specsavers website I gather they have been directed that even glaucoma patients cannot have a test more often than once a year without paying for it themselves since the regulations changed when the primary care set-up was changed in April 2013 about what the NHS will pay for. It seems to vary from one health care trust to another - the postcode lottery hits again! Your local CCG (clinical commissioning group who replaced the primary care trust) will be able to tell you more.

I asked the eye clinic at the hospital here how often it should be done and the doctor said "6- monthly" - but admitted that yearly was probably quite adequate on further questioning. I asked because here in Italy I have to go to the hospital for it to be done (opticians can't do pressures) and pay a co-pay for the appointment. Pressures don't shoot up rapidly usually so annual tests are probably adequate and once a problem is established then they would keep an eye on it.

If you have GCA, how often do you see your rheumy? They could arrange an eye exam at the hospital if it is necessary so it would be worth asking them.

On the other hand - how much would they charge for doing pressures? I suppose it depends on how much risk you feel there is involved.

[Trenny]

Many thanks, PMRpro. All is explained. It was my rheumy who suggested that I should go to the opticians, which I will do. My next appointment is in six month's time - far too long in my opinion, although my Dr is very supportive. The Rheumy is 'new' and she wants me to carry on reducing my pred. without having monthly blood tests, but going by symptons. I will discuss this with the Dr as I am not too happy about the idea. Perhaps have one every two months instead of monthly.

[PMRpro Ambassador in reply to Trenny]

Your rheumy is part of new breed who understand the limitations of the blood tests! Reductions should ALWAYS be done in line with symptoms over blood tests - they can be low but you may have symptoms. In fairness, they may be rising and you have no symptoms so both is a good idea to see if a closer eye needs to be kept on things. I was at a research meeting a couple of weeks ago and a rheumy was jumping up and down at doctors who rely on the blood tests "I NEVER look at them - there is SO much that can be wrong" . The problem is with the doctors who take the lab results as being gospel - they aren't 100% accurate, it was the reason I wasn't diagnosed for 5 years. Mine have never been even borderline never mind raised - so I can't have PMR! Sez they - but 15mg pred worked a miracle in 6 hours.

[Trenny in reply to PMRpro]

Interesting. I think that *I* have been relying on the blood test too much also. The CRP was aways 1 or 2 and then suddenly it was 20, even though I felt normal. Panic stations! Press on...

[PMRpro Ambassador in reply to Trenny]

Has that raised value been checked? There are all sorts of reasons for a raised blood test value and until it has been checked it should be treated as questionable. I had a single raised CRP - by the following week it was back to normal. I had had an unrecognised episode of atrial fibrillation at the time - could that have been the cause? No idea - but it didn't remain high.

[Trenny in reply to PMRpro]

No, I expected to have it checked at the hospital clinic, but she said not to have blood tests. I'll discuss this with my GP on Tuesday, but I don't think I have a problem

[DorsetLady PMRGCAuk volunteer]

Trenny,

According to my optician, under the new NHS regulations, free eye tests can only be allowed every 12 months. However, if you have a test under the 12 month period and your prescription has changed then you get it free!

Why specifically do you think you need a test, do you have glaucoma or a cataract? If you have a cataract (like me) then the prescription is likely to change, so you may get the test free anyway!

Hope this helps! DorsetLady

[PMRpro Ambassador in reply to DorsetLady]

It is because being on pred can cause increased eye pressures as in glaucoma - identified and treated early it is less likely to progress to the glaucoma stage. It's nothing to do with your prescription - whether your glasses are the perfect prescription or not the eye pressure can be rising and causing damage. Some people on pred develop cataracts - but I imagine you would notice one starting???? And one other thing an optician can do is see if there is any damage to the optic nerve due to GCA - your GP or rheumy can't examine the back of your eye as it needs the equipment.

[DorsetLady PMRGCAuk volunteer in reply to PMRpro]

Hi PMRPro,

Think you must have misread my post. I was enquiring what problems Trenny was experiencing- ie glaucoma or cataracts in relation to her question re eye tests.

As someone who has raised levels indicating that glaucoma could in future affect both eyes, and the beginnings of a cataract in my one "good" eye, I know that a cataract does alter the prescription in the affected eye. And yes you do know it's present. However, as it make things look blurred it could be confused with GCA symptoms or Pred side effects.

My Ophthalmologist has said that she will not operate on mine until it becomes impracticable for the change in lens prescription to cope. DorsetLady

[PMRpro Ambassador in reply to DorsetLady]

Sorry, it isn't a criticism of anything or anyone - but I don't think I misread "Why specifically do you think you need a test, do you have glaucoma or a cataract?" I was simply explaining that the test is for neither, it is simply to have the occular pressures measured. Guidelines are that they should be measured at the beginning of treatment with pred and checked at frequent intervals thereafter. It used to be a service available free every 6 months. You can have perfect vision and normal pressures before taking pred and no family history of glaucoma but in some people taking pred leads to raised pressure with no other symptoms at all. It is the pred that leads to the need for frequent checks whether you have any problems you are aware of or not - to avoid developing glaucoma. And it can happen quite quickly.

I have had regular checks all through the time I have been on pred - and basically my distance prescription is fine although it often didn't feel like it. My computer glasses moved up and down my nose as the pred had a variable effect. Now I'm on a low dose they are back to being perfect.

[Trenny in reply to PMRpro]

Why I wanted an eye test? Nothing too serious!

I wasn't happy with my last varifocal specs and thought that I might as well have another test if there was a free one available! Also no harm in checking - I wasn't sure what they were looking for at that stage. The hospital opthalmologist signed me off a year ago - six months after diagnosis and three clinic visits.

Yes, I have had a free intermediate test in the past as there was a very slight change in the prescription.

It was Eastleigh Specsavers who gave the definitive 12-month reply, 'going by the book'.

Many thanks for all the helpful answers. What a lot of knowledge we have between us and it is so good to be able to air/share our concerns.

[annihami]

Hello.j

Yes. NHS Eye Tests are usually not less than one year. Unless your optometrist has indicated other wise. Dorset Lady is quite right, if you are tested before your recall date and a change in your prescription is found , then NHS will fund the test. Or if your GP requests that you have a test Nhs will fund it. Make his request clear when booking. Alternatively look out for "offers" for private tests.

Sorry about the previous post. Its early!

Best wishes

[annihami]

The wonders of technology my messy post disappeared!

Keep smiling everyone.

[optimist-ok]

I was lucky with my Specsavers as they gave me 3monthly checks for the 1st yr with GCA/PMR. Perhaps you could try another branch, maybe get a different answer? Good luck. Another suggestion is an optical appointment at the local hospital, if that is possible. In Southampton there is an eye hospital attached to the main one.

[PMRpro Ambassador in reply to optimist-ok]

That is brilliant service - if only it was available to everyone. As I say, it is really only pressures that need checked really - a whole 10 minute performance from start to finish!

[horas]

Hi Trenny, Regarding tests costs. I am not sure if this the same type of test but Tesco don't charge for eye tests hope this might help. Regards horas