The impact of SIGN glaucoma guidelines on false-positive referrals from community optometrists in Central Scotland

Sii, Samantha; Nasser, Ahmad Bin; Loo, Cheng Yi; Croghan, Catherine F.; Rotchford, Alan P; Agarwal, Pankaj

doi:10.1136/bjophthalmol-2017-311429

Cited by 10 publications

(19 citation statements)

References 18 publications

(18 reference statements)

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“…Since then, SIGN 144 (Glaucoma referral and safe discharge) 34 has been published and this too appears to have afforded a further improvement in referral accuracy. 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.…”

Section: Effectiveness Of Traditional Case Finding and Grfsmentioning

confidence: 99%

Care pathways for glaucoma detection and monitoring in the UK

Harper

Gunn

Spry

et al. 2019

Eye

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Glaucoma presents considerable challenges in providing clinically and cost-effective care pathways. While UK population screening is not seen as justifiable, arrangements for case finding have historically been considered relatively ineffective. Detection challenges include an undetected disease burden, whether from populations failing to access services or difficulties in delivering effective case-finding strategies, and a high false positive rate from referrals via traditional case finding pathways. The enhanced General Ophthalmic Service (GOS) in Scotland and locally commissioned glaucoma referral filtering services (GRFS) elsewhere have undoubtedly reduced false positive referrals, and there is emerging evidence of effectiveness of these pathways. At the same time, it is recognised that implementing GRFS does not intrinsically reduce the burden of undetected glaucoma and late presentation, and obvious challenges remain. In terms of diagnosis and monitoring, considerable growth in capacity remains essential, and non-medical health care professional (HCP) co-management and virtual clinics continue to be important solutions in offering requisite capacity. National guidelines, commissioning recommendations, and the Common Clinical Competency Framework have clarified requirements for such services, including recommendations on training and accreditation of HCPs. At the same time, the nature of consultant-delivered care and expectations on the glaucoma specialist's role has evolved alongside these developments. Despite progress in recent decades, given projected capacity requirements, further care pathways innovations appear mandated. While the timeline for implementing potential artificial intelligence innovations in streamlining care pathways is far from established, the glaucoma burden presents an expectation that such developments will need to be at the vanguard of future developments.

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Section: Effectiveness Of Traditional Case Finding and Grfsmentioning

confidence: 99%

Care pathways for glaucoma detection and monitoring in the UK

Harper

Gunn

Spry

et al. 2019

Eye

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“…In Scotland, the Scottish Intercollegiate Guidelines Network (SIGN) is the body designed to develop evidencebased clinical guidelines for the National Health Service. 15 In 2015, SIGN published updated national clinical guidelines on glaucoma referral and safe discharge, which state that optic disc appearance should be categorised according to the DDLS system and that optometrists should consider 15 Several studies have examined the quality of glaucoma referrals by optometrists in Scotland 12,14,19,20 ; however to our knowledge this study is the first attempt to specifically examine the role of the DDLS. The study has several interesting findings.…”

Section: Discussionmentioning

confidence: 99%

“…As DDLS can be determined without recourse to expensive imaging equipment, it provides a cheap method of assessing glaucomatous structural damage that could potentially be used by optometrists, and particularly those who lack access to OCT, to improve the accuracy of decisions regarding whether patients should be referred or treated for possible glaucoma. Improving accuracy of referrals to ophthalmology services is important given that studies in the United Kingdom have shown first visit discharge rates (FVDRs) among patients referred to ophthalmologists due to suspected glaucoma of 19.4% to 43%, implying a high number of false positive referrals 12,13,14 . The 2015 Scottish Intercollegiate Guidelines Network (SIGN) glaucoma guidelines 15,16 included the recommendation that optometrists assess DDLS and provide this information when referring patients with suspected glaucoma.…”

Section: Introductionmentioning

confidence: 99%

The role of the disc damage likelihood scale in glaucoma detection by community optometrists

Formichella

Annoh

Zeri

et al. 2020

Ophthalmic Physiologic Optic

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Purpose: Recent guidelines recommend disc damage likelihood scale (DDLS) is recorded for all referrals of suspected glaucoma from community optometrists to hospital eye services (HES) in Scotland. This study aimed to determine whether lower DDLS grades were associated with higher rates of discharge at the first visit to HES. Methods: A retrospective analysis of 618 consecutive new referrals from community optometrists to a university hospital glaucoma service. 65 (10.5%) included DDLS graded by the community optometrist. A comprehensive eye examination and optical coherence tomography (OCT) was performed in the hospital glaucoma clinic and first visit discharge rate (FVDR) for different grades of DDLS compared. The relationship between DDLS and retinal nerve fibre layer (RNFL) thickness on OCT was also examined. Results: The FVDR for patients with DDLS recorded in the referral was 27.7% (18 of 65) compared to 25% (138 of 553) in those without DDLS (p = 0.631). The FVDR was 50% for those with a DDLS of 3 in the worse eye, decreasing to 32% and 21% for DDLS grades of 4 and 5 respectively. No patient with a DDLS ≥ 6 was discharged at the first visit and none with a DDLS < 4 (the cut off for consideration of referral in Scottish guidelines) were found to have glaucoma. There was a significant but weak inverse relationship between DDLS and RNFL thickness. The strongest relationship was with average RNFL thickness (r = À0.378, p < 0.01) followed by superotemporal (r = À0.359, p < 0.01) and inferotemporal (r = À0.353, p < 0.01) RNFL thickness. Conclusions: In patients referred to HES with DDLS information included, lower DDLS grading was associated with higher odds of being discharged at the first visit. DDLS grading by community optometrists had a poor correlation with RNFL thickness measured using OCT.

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“…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 .…”

Section: Comparison Between Eye‐care Models and Supporting Evidencementioning

confidence: 99%

“…In a recent paper the impact of the SIGN glaucoma guidelines on community optometrists’ glaucoma referrals was assessed. The study found that there is still room for improved adherence to referral criteria and it was pointed out that reasons for lower than anticipated adherence may include the complexity of some of the guidance tools …”

Section: Comparison Between Eye‐care Models and Supporting Evidencementioning

confidence: 99%

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

Jonuscheit

Löffler

Strang

2019

Ophthalmic Physiologic Optic

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The impact of SIGN glaucoma guidelines on false-positive referrals from community optometrists in Central Scotland

Abstract: Patients referred after the introduction of SIGN guidelines were 33.5% less likely to be discharged at the first visit. Although compliance to most recommendations in SIGN guidelines has improved, there is still a need to improve adherence to referral criteria.

Cited by 10 publications

References 18 publications

Care pathways for glaucoma detection and monitoring in the UK

Care pathways for glaucoma detection and monitoring in the UK

The role of the disc damage likelihood scale in glaucoma detection by community optometrists

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

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