Implementing collaborative care for glaucoma patients and suspects in Australia

Huang, Jessie; Hennessy, Michael; Kalloniatis, Michael; Zangerl, Barbara

doi:10.1111/ceo.13187

Cited by 21 publications

(36 citation statements)

References 4 publications

(6 reference statements)

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“…Opportunistic cases finding by community‐based optometrists accounted for more than 90% of all glaucoma referrals in the United Kingdom, while office‐based opportunistic screening has been proposed as a feasible model in the United States . In Australia, a hybrid model of collaborative care for glaucoma patients and suspects between ophthalmologists and optometrists have been proposed . The current unmet demand for glaucoma care is a big challenge in China.…”

Section: Discussionmentioning

confidence: 99%

Integrating opportunistic glaucoma screening into general health examinations in China: A pilot study

Zhang

Sun

Liu

et al. 2019

Clinical Exper Ophthalmology

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Importance Under‐detection and late diagnosis are major causes of glaucoma‐related visual impairment. Cost‐effective opportunistic glaucoma screening is of great interest in the early identification and prevention of glaucoma. Background To describe the results of a health examination centre‐based opportunistic glaucoma screening and referral model. Design This single centre cross‐sectional study was conducted in a health examination centre affiliated to a tertiary hospital in Shenyang, northeastern China. Participants From 21 March to 30 September 2016, 14 367 individuals aged ≥ 30 years undergoing routine physical examinations were invited for this glaucoma screening. Methods Presenting visual acuity, non‐contact pneumotonometry and non‐mydriatic fundus photography were evaluated. Fundus photographs were classified as non‐glaucoma, possible, probable and definitive glaucoma. Participants with probable and definite glaucomatous discs or intraocular pressure ≥ 24 mmHg were referred for definitive examinations. Main Outcome Measures Detection rate of glaucoma suspects and ocular hypertension (OHT). Cost to identify a single case with suspected and diagnosed glaucoma was also calculated. Results Altogether, 277 glaucoma suspects and 327 ocular hypertension suspects were identified. Among 190 participants with probable/definite glaucomatous discs, 93 (48.9%) accepted further examination. Among these, 78 were diagnosed as glaucoma, seven as suspects and eight were excluded. Only 98 ocular hypertension suspects (30.0%) accepted further examinations: eight had primary angle closure and 23 had confirmed ocular hypertension. The cost to identify a single glaucoma suspect and definite glaucoma case were US$135 and US$857, respectively. Conclusions and Relevance This novel screening model provides opportunities to improve glaucoma detection at low cost. Interventions to improve follow‐up are needed.

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Section: Discussionmentioning

confidence: 99%

Integrating opportunistic glaucoma screening into general health examinations in China: A pilot study

Zhang

Sun

Liu

et al. 2019

Clinical Exper Ophthalmology

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“…The present study evaluated the effect of a new, recently activated referral pathway on improving triaging effectiveness and patient outcomes for angle closure spectrum disease. This pathway was put in place after noting that other existing glaucoma‐specific patient pathways do not necessarily regard angle closure spectrum disease as a distinct entity requiring a separate triage process. In doing so, this study sought to evaluate potential reasons for pathway utilisation in order to guide further improvements to the system.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, there were few cases where the final treatment or prognostic outcome could be confirmed, due to the nature of CFEH as a referral‐only intermediate‐tier clinic . Notably though, of the 12 patients in the Angle Suites group who required intervention (laser or surgical), four met the criteria for collaborative care within the local health district and were managed by the CFEH collaborative care glaucoma clinic …”

Section: Discussionmentioning

confidence: 99%

“…Services offered by CFEH have been explained elsewhere . Within a Glaucoma Suite, a battery of glaucoma‐related tests (Table ) are performed for the patient, and a final diagnosis and recommended management are provided.…”

Section: Methodsmentioning

confidence: 99%

“…The increase in prevalence of glaucoma, as a consequence of an increasing ageing population, will continue to place a burden on health‐care systems, particularly where patients with poorly defined risk factors are referred to an ophthalmologist for diagnosis and management . Collaborative care models in which primary care optometrists deliver diagnostic and treatment services may assist in alleviating the stress upon the relative shortage of ophthalmology services, by specifically reducing the incidence of false positive referrals to ophthalmologists and improving the maintenance of appropriate clinical follow‐up for glaucoma suspect patients . In doing so, ophthalmology services can be directed to the treatment of specific patients with glaucoma, address other demands for specialised eye care, and may ultimately represent cost savings to the health‐care system …”

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confidence: 99%

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A collaborative care pathway for patients with suspected angle closure glaucoma spectrum disease

Phu

Hennessy

Spargo

et al. 2020

Clinical and Experimental Optometry

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Background Currently, no specific collaborative care pathway exists that distinguishes open angle glaucoma from narrow angle or angle closure disease. This study evaluates a newly developed referral and collaborative care pathway specifically for patients with angle closure spectrum disease. Methods The medical records of consecutive patients referred to the Centre for Eye Health for glaucoma assessment were examined, six months before (Pre Suite) and after (Post Suite) the introduction of a novel referral pathway for anterior chamber angle assessment (Angle Suite). Patient demographic and clinical data, the referral letter and practitioner characteristics were extracted. Results Angle Suite (n = 77) patients had an appointment much sooner compared to Pre (n = 383) and Post Suite (n = 425) patients (p < 0.0001). Following the introduction of Angle Suites, there was a reduction of incidental angle closure disease found in routine, non‐angle closure glaucoma assessment. Onward referral was required by 36.4 per cent of patients referred for suspected angle closure disease, while the rest could be discharged back into the community (13.0 per cent) or reviewed at the Centre for Eye Health (50.6 per cent). Multinomial logistic regression found that the presence of an angle description in the referral letter improved the true positive rate for angle closure disease (p < 0.0001). Conclusions The clinical pathway may reduce the number of incidental angle closure patients and improved the timeliness of appropriate clinical care delivered to a subset of patients who may benefit from prompt medical attention. This pathway provides an opportunity for appropriately staffed and equipped collaborative care clinics to reduce the burden on tertiary level ophthalmic facilities.

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Ability of 24-2C and 24-2 Grids to Identify Central Visual Field Defects and Structure-Function Concordance in Glaucoma and Suspects

Phu¹,

Kalloniatis²

2020

American Journal of Ophthalmology

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The purpose of this study was to compare the ability of the 24-2 test grid with that of the 24-2C test grid to measure visual field global indices, identify central visual field defects, and facilitate macular structure-function analysis with optical coherence tomography (OCT) scans in glaucoma suspects and glaucoma patients.DESIGN: Prospective, cross-sectional study. METHODS: One eye from each of 100 glaucoma suspects and glaucoma patients (60 undergoing SITA-Faster [Zeiss Meditec] testing on 24-2 and 24-2C; 40 undergoing SITA-Standard [Zeiss Meditec] testing on 24-2 and SITA-Faster on 24-2C) were included in the study. Global visual field indices, test duration, and pattern deviation results were extracted. The deviation map from the Cirrus OCT (Carl Zeiss Meditec) Ganglion Cell Analysis (GCA) was extracted, and structure-function relationships were compared after correction of the visual field test stimulus location that stimulated the corresponding retinal ganglion cell.RESULTS: Global index results of the 24-2 grid were similar to those of the 24-2C grid, and both identified a comparable number of clusters of visual field defects. Centrally, the 24-2C grid identified more clusters of defects than the 24-2 grid, but this was not statistically significant. Although the 24-2C test locations resulted in more instances of structure-function concordance than the 24-2 locations, half the locations in the 24-2C grid fell close to or outside the GCA grid when corrected for ganglion cell displacement.CONCLUSIONS: The 24-2C returned global visual field indices similar to the 24-2 grid but tended to identify more clusters of central functional defects. Central structure-function concordance was better achieved using the 24-2C grid, but half of the visual field test loca-Supplemental Material available at AJO.com.

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Implementing collaborative care for glaucoma patients and suspects in Australia

Cited by 21 publications

References 4 publications

Integrating opportunistic glaucoma screening into general health examinations in China: A pilot study

Integrating opportunistic glaucoma screening into general health examinations in China: A pilot study

A collaborative care pathway for patients with suspected angle closure glaucoma spectrum disease

Ability of 24-2C and 24-2 Grids to Identify Central Visual Field Defects and Structure-Function Concordance in Glaucoma and Suspects

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