Abstract
Background/Aims
To describe the design, activity, and quality of the referral refinement phase of a novel glaucoma shared-care scheme.
Methods
Eight Optometrists with a Specialist Interest in glaucoma (OSI) were trained to perform a community-based comprehensive glaucoma evaluation of low-risk glaucoma hospital referrals (only one/none of the following factors noted for either eye: abnormal optic disc, abnormal visual field, abnormal intraocular pressure (IOP; 22–28 mmHg or IOP asymmetry)) using equipment standardized to that of the hospital glaucoma service.
Results
One hundred and thirty-eight (27%) of a total of 512 glaucoma-related referrals were deemed ‘low risk’. Their choice of OSI discharged 40 (35%). The consultant agreed (virtually) with the decision to discharge with 28 (70%) and disagreed with 12 (30%). Comparing findings between OSI and consultant for 99 referred patients, sensitivity, specificity, and negative predictive values for a suspicious optic disc were 78, 61, and 79%, respectively. For an IOP of >21 mmHg, they were 74, 85, and 90%, respectively. For an occludable anterior chamber angle (Van Herick's versus gonioscopy), they were 69, 88, and 94%, respectively.
Conclusion
This referral refinement process can reduce numbers of false-positive referrals attending the hospital glaucoma service while retaining a relatively high level of examination quality.
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Acknowledgements
The authors thank the eight optometrists with a specialist interest in glaucoma (Sue Martynski, Caroline Hurst, Alison Hammond, Lesley Hodgson, Sally Bushby, Angela Wimpenny, John Kidd, Keziah Latham) and the community eye services department at Hinchingbrooke Hospital (Alison Hammond and Bridget Wilson). Karen Hayton and Gene Dunbar of the former Huntingdon Primary Care Trust are thanked for their collaborative efforts.
Financial support from Allergan Inc., (Irvine, CA, USA) is gratefully acknowledged in the form of an unrestricted grant for a Glaucoma Fellowship (LC) and also in the form of a Diagnostic Innovations in Glaucoma Care award to the CHANGES scheme in 2007.
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Bourne, R., French, K., Chang, L. et al. Can a community optometrist-based referral refinement scheme reduce false-positive glaucoma hospital referrals without compromising quality of care? The community and hospital allied network glaucoma evaluation scheme (CHANGES). Eye 24, 881–887 (2010). https://doi.org/10.1038/eye.2009.190
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DOI: https://doi.org/10.1038/eye.2009.190
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