Agreement between specially trained and accredited optometrists and glaucoma specialist consultant ophthalmologists in their management of glaucoma patients

Abstract

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.

The effect of changes in referral behaviour following NICE guideline publication on agreement of examination findings between professionals in an established glaucoma referral refinement pathway: The Health Innovation & Education Cluster (HIEC) Glaucoma Pathways project

“…It has demonstrated that community based optometrists with a special interest in glaucoma (OSI) can effectively reduce the number of unnecessary referrals attending the hospital glaucoma service in low risk patients 9. Good agreement between the examination findings of a specialist optometrist in glaucoma and the hospital were reported with this and other schemes before the National Institute for Health and Clinical Excellence (NICE) glaucoma guidelines were published in April 2009 6 7 9 11 12. The publication of the NICE guidelines prompted a recommendation from the Association of Optometrists (AOP) to refer all patients with an IOP of greater than 21 mm Hg regardless of the method of measurement 20 21…”

The Peterborough Scheme for Community Specialist Optometrists in Glaucoma: Results of 4 Years of a Two-Tiered Community-Based Assessment and Follow-up Service

“…Similar schemes of optometrist involvement in the investigation or management of glaucoma have been reported elsewhere, notably Bristol, Manchester, Carmarthenshire, Portsmouth and Huntingdon. 2,[9][10][11][12][13][14][15] In some instances, optometrists work within hospital glaucoma clinics alongside a consultant-led service. In other cases, specially trained community optometrists are used within a referral-refinement process whereby the optometrist acts as an intermediary between the community optometrist referral and entry into the hospital eye service, designed to filter out falsepositive referrals.…”

The Prevalence of Visual Impairment in People with Dementia (the PrOVIDe study): a cross-sectional study of people aged 60–89 years with dementia and qualitative exploration of individual, carer and professional perspectives

“…There are long-standing UK precedents for the development of specialist optometrists in contact lenses and orthoptics and, more recently, in therapeutics 132 and glaucoma. 133,134 However, the process of establishing a specialist qualification for optometrists is lengthy, requiring the drafting of a syllabus, core competencies, training programmes and assessment procedures. 135 The viability of a specialist qualification should be a topic for further research.…”