Glaucoma Community Care: Does Ongoing Shared Care Work?

Abstract

We assessed a novel, public, vertical integrated care model for glaucoma management in the community. Methods: This study was a retrospective, longitudinal study of 266 patients diagnosed or suspected of glaucoma. Patients were stratified to either ongoing ophthalmology-led (n = 81) or optometry-led shared care (n = 185). Demographics and clinical characteristics, including the re-referral rate and timeliness of follow up were analysed. Results: Just under half (565/1224, 46%) of all follow up consultations over the total study period of 45 months were seen in optometry-led care, with a re-referral rate to ophthalmology of 21%. Treated patients showed a median intraocular pressure reduction of 20% and a median time delay of just two days between the actual and recommended review period. Conclusions: Shared care provides an effective option for managing the ongoing care burden in chronic stable glaucoma cases at low risk of vision loss.

Prediction of visual field defects from macular optical coherence tomography in glaucoma using cluster analysis

“…All glaucoma participants had received their diagnosis from a glaucoma specialist ophthalmologist, and either previously underwent selective laser trabeculoplasty or peripheral iridotomy or were prescribed topical therapy at the time of recruitment. The majority of participants were classified as having early glaucoma, as described in previous studies 35,36 . Data from all of the healthy participants and 25 of the glaucoma participants have been reported in part in previous investigations 31–33,36–39 .…”

“…The majority of participants were classified as having early glaucoma, as described in previous studies. 35,36 Data from all of the healthy participants and 25 of the glaucoma participants have been reported in part in previous investigations . [31][32][33][36][37][38][39] As per previous studies, [31][32][33]37 exclusion criteria for all cohorts included spherical equivalent refractive error outside the range of ±6.00 dioptres (D), astigmatism greater than 3.00 D and the presence of macula pathology in the included eye.…”

Glaucoma Suspects: The Impact of Risk Factor-Driven Review Periods on Clinical Load, Diagnoses, and Healthcare Costs

“… 24 Specifically, the higher risk nature of the patients seen in the clinic means that the diagnosis rates of glaucoma are expectedly higher compared to rates obtained from community practice (our previous study 11 on consecutively referred patients found that approximately 14% received a diagnosis of glaucoma). Attending clinicians within the Centre for Eye Health have been shown to have higher positive predictive values and lower false-positive rates for glaucoma diagnosis compared to community optometrists, 25 have been providing effective ongoing glaucoma shared care since its inception, 26 and have shown high concordance in important metrics related to glaucoma assessment. 23 …”

High sampling resolution optical coherence tomography reveals potential concurrent reductions in ganglion cell‐inner plexiform and inner nuclear layer thickness but not in outer retinal thickness in glaucoma

“…All participants in the glaucoma cohort had been previously diagnosed with open-angle glaucoma in at least one eye by a glaucoma specialist ophthalmologist working within the Centre for Eye Health as part of a collaborative care arrangement with optometrists. Per previous studies and modern glaucoma diagnostic paradigms, 30,[32][33][34] the diagnostic criteria applied included (1)…”