Aims Optometrists are becoming increasingly involved in the co-management of glaucoma patients as the burden on the Hospital Eye Service continues to escalate. The aim of this study was to assess the agreement between specially trained optometrists and glaucoma-specialist consultant ophthalmologists in their management of glaucoma patients. Methods Four optometrists examined 23-25 patients each and the clinical findings, up to the point of dilation, were documented in the hospital records. The optometrist, and one of two consultant ophthalmologists, then independently examined and documented the optic-disc appearance before recording their decisions regarding the stability and management of the patient on a specially designed proforma. Percentage agreement was calculated together with kappa or weighted kappa statistics, where appropriate. Results Agreement between consultants and optometrists in evaluating glaucoma stability was 68.5% (kappa (k) ¼ 0.42-0.50) for visual fields, 64.5% (weighted k ¼ 0.17-0.31) for optic discs, and 84.5% (weighted k ¼ 0.55-0.60) for intraocular pressures. Agreement regarding medical management was 96.5% (k ¼ 0.73-0.81) and for other glaucoma management decisions, including timing of follow-up, referral to a consultant ophthalmologist, and discharge, was 72% (weighted k ¼ 0.65). This agreement increased to 90% following a retrospective independent then consensus review between the two consultants and when qualified agreements were included. Of the 47 glaucoma and nonglaucoma queries generated during the study, 42 resulted in a change of management. Conclusion Confirming the ability of optometrists to make appropriate decisions regarding the stability and management of glaucoma patients is essential if their involvement is to continue to develop to meet the demand of an aging population.

Purpose: To investigate the value of intraocular pressure phasing during normal working hours in patients with and without anti‐glaucoma treatment. Methods: This study is a retrospective case note review of 61 patients referred for intraocular pressure phasing (every 2 hours from 8.00am to 4.00pm). Comparison between pre‐phasing intraocular pressure measurements (mean and range) taken during earlier routine visits (5 measurements) and phasing intraocular pressure (mean and range) for each eye was performed using paired t‐test. Scatter plots were used to display the relationship of pre‐phasing and phasing intraocular pressure. Subgroup analysis of 119 eyes into untreated and medically treated groups was performed. Results: Eyes in the untreated group (51 eyes) showed no difference between the mean intraocular pressure at pre‐phasing and phasing (p value=0.8) but a significant difference between the intraocular pressure range (p value=0.007). For the medically treated group (68 eyes), there was no significant difference between the mean intraocular pressure at pre‐phasing and phasing (p value=0.9) and no significant difference between the intraocular pressure range (p value=0.66). In the total 119 eyes the peak intraocular pressure was found to occur at 10‐11am. Conclusions: Intraocular pressure phasing is most useful on untreated patients. Intraocular pressure phasing is less likely to give much additional data, compared to pre‐phasing intraocular pressure measurements, in treated patients. If a clinician wanted to identify the peak intraocular pressure the best time is between 10‐11 am.