1.1 The Trust has a major commitment to research addressing questions relevant to the interface between community health workers (GPs, optometrists, orthoptists, nurses) and the specialist services provided by Moorfields. This is important because, with some exceptions, general practitioners do not have the time or the equipment to identify the majority of sight threatening diseases, particularly those that are asymptomatic. In line with government strategy we are developing integration to provide comprehensive community eye care.

1.2 Our programme of research addresses operational and clinical aspects of care at the community interface. This includes collaborative projects with community workers and specialist services in addition to research within the primary care service. Having a well established, 'one-stop' primary care service in the hospital setting, our programme addresses issues of access to relevant services and diagnostics to facilitate delivery of the most appropriate packages of care. There is compelling evidence of a high level of undetected and untreated morbidity in the population, particularly in underprivileged areas. A number of projects therefore focus on improving access to ophthalmology advice and services and include:

1.2.1 An investigation into reasons for failure of ethnic minority communities to access available eye health services has identified several key areas for intervention. A further trial addressed the issues of communication between healthcare professionals and patients for whom English is not their first language.

1.2.2 Trials of a nurse led glaucoma clinic and 'shared care' with community optometrists, are ongoing.

1.2.3 A series of projects aimed at achieving improved interaction with community optometrists in providing ophthalmic healthcare for the community. Current optometric practice in case-finding for glaucoma has been studied in detail and an intervention strategy based on the findings was developed and tested in pilot studies. A controlled trial investigating the impact of an education package on the positive predictive value of optometric referrals for suspected glaucoma has now completed data collection. A positive effect has been shown with twice the number of new glaucoma cases being identified in the intervention group. We have now extended the intervention to all optometrists in the area. Finally a new project has been developed to determine the influence of a public health campaign on optometry and other eye health seeking behaviour in the population. A pilot study commenced and a funding decision is awaited for the main project.

1.3 In addition to improving access and take-up of available services we also have a number of projects focusing on the most effective and efficient use of diagnostic and therapeutic services and optimum models of healthcare delivery. These include:

1.3.1 Modelling of appropriate screening services for diabetic ocular pathology. A successful pilot project involving a screening service by an optometrist within the existent medical retina clinic at Ealing Hospital is progressing to service development stage.

1.3.2 Collaborative projects with other specialist services and the Institute of Ophthalmology focusing on the clinical aspects of patients attending primary care, including improved assessment techniques in visual acuity, intraocular pressure assessment, ocular hypertension and cataract grading.

1.4 The most exciting aspect of primary care research in terms of potential impact and improvement to access, investigations and therapeutic advice, lies in the area of telemedicine. The Trust has taken a lead in this field. A telemedicine link between Ealing and City Road is well established and research into triage of A&E attendances for eye complaints is underway. Our research programme addresses issues concerning improved access for patients to high technology diagnostic and therapeutic equipment in outreach locally, nationally and across the world.