Advanced clinical practice in paediatric ophthalmology: a service evaluation of clinic implementation and the first three years of practice

<i>Purpose:</i> Increasing demand within paediatric ophthalmology services presents a growing challenge to timely and effective patient care. Advanced Clinical Practice (ACP) roles have emerged as a strategy to extend clinical capacity and alleviate consultant and medical workload. This service evaluation explores the early impact of an ACP clinic at Oxford University Hospitals NHS Foundation Trust. <i>Methods:</i> A retrospective analysis was conducted of all patients seen in the ACP clinic between the August 12, 2022, and the September 19, 2025. Data collected included patient demographics, ophthalmic diagnosis, management outcome, and whether consultant ophthalmologist input was required. The clinic accepted referrals across the full range of paediatric ophthalmology. <i>Results:</i> A total of 278 patient appointments were conducted over the evaluation period. 66% were managed independently by the ACP. Consultant input was required in 34% of cases, with the most common reason being the need for prescribing (53%), which the ACP was not authorized to provide. Diagnoses seen ranged from anterior segment disease, eyelid conditions, and posterior segment presentations, with the most common diagnosis being chalazia making up 23% of presentations. The most common management given to patients was reassurance prior to discharge (33%) followed by pharmacological management (26%), active monitoring (22%), conservative advice (16%), and surgical listing (3%). <i>Conclusion:</i> The ACP clinic safely managed a wide variety of cases that would otherwise have required consultant appointments, significantly reducing medical workload. Limitations included the inability to prescribe independently, restricting clinical autonomy. This model demonstrates the potential for ACPs to enhance paediatric ophthalmology services and highlights areas for future role development.