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ObjectivesA comparison of glaucoma referral refinement schemes (GRRS) in the UK during a time period of considerable change in national policy and guidance.DesignRetrospective multisite review.SettingThe outcomes of clinical examinations by optometrists with a specialist interest in glaucoma (OSIs) were compared with optometrists with no specialist interest in glaucoma (non-OSIs). Data from Huntingdon and Nottingham assessed non-OSI findings, while Manchester and Gloucestershire reviewed OSI findings.Participants1086 patients. 434 patients were from Huntingdon, 179 from Manchester, 204 from Gloucestershire and 269 from Nottingham.ResultsThe first-visit discharge rate (FVDR) for all time periods for OSIs was 14.1% compared with 36.1% from non-OSIs (difference 22%, CI 16.9% to 26.7%; p<0.001). The FVDR increased after the April 2009 National Institute for Health and Clinical Excellence (NICE) glaucoma guidelines compared with pre-NICE, which was particularly evident when pre-NICE was compared with the current practice time period (OSIs 6.2–17.2%, difference 11%, CI −24.7% to 4.3%; p=0.18, non-OSIs 29.2–43.9%, difference 14.7%, CI −27.8% to −0.30%; p=0.03). Elevated intraocular pressure (IOP) was the commonest reason for referral for OSIs and non-OSIs, 28.7% and 36.1%, respectively, of total referrals. The proportion of referrals for elevated IOP increased from 10.9% pre-NICE to 28.0% post-NICE for OSIs, and from 19% to 45.1% for non-OSIs.ConclusionsIn terms of ‘demand management’, OSIs can reduce FVDR of patients reviewed in secondary care; however, in terms of ‘patient safety’ this study also shows that overemphasis on IOP as a criterion for referral is having an adverse effect on both the non-OSIs and indeed the OSIs ability to detect glaucomatous optic nerve features. It is recommended that referral letters from non-OSIs be stratified for risk, directing high-risk patients straight to secondary care, and low-risk patients to OSIs.

Purpose To investigate the relationship between socioeconomic status and the extent of visual field loss in POAG and treated OHT patients at their first presentation to Manchester Royal Eye Hospital. Methods A cohort of 113 glaucoma patients seen between 1995 and 2005 was reviewed. The clinical parameters intraocular pressure, C : D ratio, family history of glaucoma, visual acuity, extent of visual field loss, and demographic parameters: age, gender, ethnicity, and residential postcode were extracted from hospital records. The socioeconomic status of each patient was estimated from the patient's residential postcode with the ACORN index (group 1: affluent and group 2: socioeconomically deprived). Results In comparison to group 1 (n ¼ 49), patients in group 2 (n ¼ 64) presented with more advanced field loss, lower educational attainment (18 vs 98% with no or unknown qualification), and were less aware of glaucoma in the family (27 vs 17%). Patients with a number of systemic health problems had worse vision, more severe visual field loss, and worse clinical attendance (Po0.05). Conclusions The extent of visual field loss in glaucoma patients at first presentation is related to a combination of clinical and socioeconomic factors including the patient's postcode. This finding could be used to target future case-finding resources.

BackgroundIn this study the authors sought both to understand the health education needs of patients with glaucoma, with particular regard to adherence to glaucoma treatment, and to examine these patients’ views of group education.MethodsUsing a health promotion approach to health education, 27 qualitative interviews with new and established patients receiving glaucoma treatment were conducted. Health promotion is defined as a way of strengthening people’s capacities to control and optimize their own health. The interviews were transcribed and were then analyzed thematicallyResultsNine categories of health education needs were identified from the transcripts: (1) to understand glaucoma; (2) to understand their diagnosis or understand the difficulties in giving a diagnosis; (3) to understand the implications of eye drops, their side effects, and how to renew the eye drops; (4) to feel confident to put in eye drops; (5) to put the condition into perspective - to know how to manage their risk; (6) to be able to ask questions of clinicians; (7) to be able to navigate the health care system; (8) to understand and be able to manage own adherence behavior; and (9) to know where to access other sources of information. The majority of patients had something positive to say about group education, and about half of the patients said they would attend group education if they were offered the opportunity.ConclusionA health promotion approach identified a wide range of patient-centered health education needs regarding adherence to glaucoma treatment. Group education will be attractive to some patients. Clinicians could use the health education needs identified in this study to guide the development of either individual or group-based educational intervention to improve adherence to glaucoma treatment. However, clinicians need to be aware that when developing a group intervention, attention will need to be given to making the education relevant to the circumstances of each patient.