Abstract
Background
The Royal College of Physicians (RCP) and Thyroid Eye Disease Amsterdam Declaration Implementation Group (TEAMeD-5) have the common goal of improving access to high quality care for thyroid eye disease (TED). The TEAMeD-5 programme recommends all patients with moderate-to-severe TED should have access to multidisciplinary clinics (MDT) with combined Ophthalmology and Endocrinology expertise.
Methods
The British Oculoplastic Surgery Society represents oculoplastic surgeons who usually lead TED care in the UK. A two-stage survey of the membership was conducted to ascertain current practice of existing resources.
Results
Seventy percent (45/65) of respondents in Survey 1 were aware of current RCP guidance, but only 49% (22/45) rated it as a good means of improving access to comprehensive TED service. Sixty percent (39/65) of respondents are working in a multidisciplinary TED clinic with co-___location of ophthalmologists and endocrinologists. Care for TED appears not to be provided in a multidisciplinary context in up to 31% (20/65). Thirty five (54%) of the respondents rated their relationship with endocrinology colleagues as good. Best practice guidelines recommend routine quality of life assessments but only 6/28 (21%) of respondents use this modality in current practice. Six percent (4/65) of areas appear not to be using intravenous steroids. In many areas (25%, 16/65), second-line immunosuppression is provided in a different trust and in 8% (5/65), it appears not to be used at all.
Conclusion
This survey is a ‘snapshot’ of current TED management in the UK and findings suggest scope for improvement. We recommend a framework for more robust collaboration across specialties and propose standards endorsed by multidisciplinary stakeholder societies.
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Acknowledgements
The recommendations in this paper have been endorsed by TEAMeD, BOPSS, Royal College of Ophthalmologists, The Royal College of Physicians, Society for Endocrinology, British Thyroid Foundation and the British and Irish Orthoptic Society. The authors would like to thank the BOPSS Thyroid Audit Standards Group: Vikas Chadha, Lucy Clarke, Rebecca Ford, Anjana Haridas, Carole Jones (BOPSS president 2018), Faye Mellington, Rachna Murthy, Jonathan Norris, Cornelius Rene (BOPSS president 2016–2018), Sachin Salvi, Jimmy Uddin, Colin Vize (BOPSS secretary) and Stephen White and the BOPSS membership for completing the surveys. The authors also thank Janis Hickey (British Thyroid Foundation) and Lorna Pankethman (British and Irish Orthoptic Society) for their support and recommendations. The authors would like to thank TEDct for their generous donation that made it possible for this paper to be open access.
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Ben Williams is the Webmaster for BOPSS and is renumerated for providing IT support. None of the other authors or contributors have any conflict of interest to declare.
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Lee, V., Avari, P., Williams, B. et al. A survey of current practices by the British Oculoplastic Surgery Society (BOPSS) and recommendations for delivering a sustainable multidisciplinary approach to thyroid eye disease in the United Kingdom. Eye 34, 1662–1671 (2020). https://doi.org/10.1038/s41433-019-0664-z
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DOI: https://doi.org/10.1038/s41433-019-0664-z
