Accuracy of detection of patients with narrow angles by community optometrists in Scotland

Abstract

Aim: To examine the accuracy of referrals by community optometrists for suspected primary angle closure, including primary angle closure suspects, primary angle closure and primary angle closure glaucoma. Methods: A retrospective review of 769 consecutive patients referred by community optometrists to the glaucoma clinic at a university hospital in Scotland. Ninety-five of 715 eligible subjects (13%) were referred due to suspected angle closure. All subjects had a comprehensive eye examination in the glaucoma clinic, including gonioscopy, with angle closure defined according to the International Society of Geographical and Epidemiological Ophthalmology classification as iridotrabecular contact over at least 270 degrees. Results: Fifty-nine of 95 subjects referred due to suspected angle closure were confirmed to have an occludable angle, while 36 of 95 (38%) had open angles (positive predictive value = 62%). Of 620 patients referred to the glaucoma clinic for reasons other than narrow angles, 601 (97%) had open angles on gonioscopy and 19 (3%) had narrow angles.Using the 620 patients referred with 'open angles' as a control group, sensitivity was estimated as 76% and specificity 94%. Eleven of 95 (12%) patients referred for possible angle closure were discharged at the first visit compared to 156 of 620 (25%) referred to the glaucoma clinic for other reasons (p = 0.003). In a multivariable model, suspect angle closure detected by the optometrist (OR = 56.0, 95% CI 35.2-89.2, p < 0.001) and female gender (OR = 1.9, 95% CI 1.2-3.1, p = 0.008) were associated with increased odds of angle closure on gonioscopy. Conclusion: Community optometrists had good ability to detect eyes at risk of angle closure. There was also greater accuracy of referrals for suspected angle closure than for other glaucoma referrals.

Care pathways for glaucoma detection and monitoring in the UK

“…In a retrospective study, Sii et al 35 observed a significant decline in the first visit discharge rate when comparing two 2-month periods both before (29.2% first visit discharge rate) and after (19.2% first visit discharge rate ) the publication of SIGN 144, while also observing room for improved adherence to referral criteria. On a more specific clinical query, Annoh et al 36 recently examined the accuracy of referrals for primary angle closure related diagnoses in Scotland. In 769 consecutive referrals they determined that community optometrists had 'good' ability to detect eyes at risk of angle closure, with only 12% of those referred for possible angle closure being discharged at the first visit.…”

Digital Image Analysis of the Angle and Optic Nerve: A Simple, Fast, and Low-Cost Method for Glaucoma Assessment

“…In addition, given the needed training in an optometry setting, such assessment can reduce the number of referrals for double screening, which takes on patient time, and which may also lead to disease progression. is will also provide a form of standardization for the rising concern about optometrists using gonioscopy in the primary care setting for glaucoma detection and the need for training nonophthalmic personnel in screening techniques, which can increase the sensitivity and specificity to a level of accurate positive prediction (62%) [45][46][47][48].…”

General ophthalmic services in Scotland: value for (public) money?

“…A number of peer‐reviewed studies have evaluated aspects of the new Scottish GOS contract including the quality of referrals, access to and distribution of services, the use of clinical equipment and practitioner preferences relating to the management of ocular conditions. One particular area that has attracted the attention of researchers is the impact of the new GOS contract on the quality of glaucoma referrals . Comparing the quality of more than 300 glaucoma referrals before and after the new GOS, Ang et al .…”

“…A recent retrospective case review investigated the accuracy of referrals for suspected primary angle closure over a 6‐month period in 2016 (10 years after the introduction of the new GOS) and indicated that optometrists possess a good ability to diagnose narrow angles correctly …”

“…One particular area that has attracted the attention of researchers is the impact of the new GOS contract on the quality of glaucoma referrals. [8][9][10][11] Comparing the quality of more than 300 glaucoma referrals before and after the new GOS, Ang et al 8 showed that outcomes and quality of glaucoma referrals have improved based on an increased rate of true positives and fewer cases of false positive referrals. El-Assal et al 9 used hospital glaucoma patient data from more than 1600 patients over a 12-year period (2000-2012), with the introduction of the new GOS at the midpoint of this period.…”