The Peterborough scheme for community specialist optometrists in glaucoma: a feasibility study

Abstract

Purpose This study assessed the role of specialist optometrists who were working in the community and sharing the care for glaucoma patients with, and under close supervision of, a consultant ophthalmologist working in the Hospital Eye Services (HES) to ensure high-quality standards, safety, and care. Methods From February 2005 onwards, the majority of all new glaucoma referrals to our eye department were diverted to our specialist optometrists in glaucoma (SOGs) in their own community practices. Selected patients in the HES setting who were already diagnosed with stable glaucoma were also transferred to the SOGs. The completed clinical finding details of the SOGs, including fundus photographs and Humphrey visual field tests, were scrutinised by the project lead.

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

“…The fact that the relatively high percentage agreement for optic-disc status was not reflected in the kappa value may have occurred because the majority of discs were classified as stable or probably stable. 15 None of the previous studies 4, [9][10][11] included an assessment of optic-disc stability and the results for VF analysis varied considerably, with Banes et al 4 reporting a fair level of agreement (55%, k ¼ 0.33) and Ho and Vernon 11 reporting an almost perfect level of agreement (90.2%, k ¼ 0.84)-a result that may have been influenced by the fact that the ophthalmologist was not masked to the optometrist's decisions. Notwithstanding, the difficulty in correctly identifying progressive optic disc and VF changes has previously been well documented and the agreement levels achieved by our optometrists are similar to those of other studies comparing glaucoma specialists.…”

“…14 To our knowledge, there have been two previous studies that have compared the management decisions made by optometrists working within the hospital glaucoma service with those of consultant ophthalmologists 4,11 and three involving specially trained community optometrists assessing new referrals, 8 diagnosed glaucoma/glaucoma suspect patients 9 , or a combination of both. 10 Although all of these optometrists had undergone additional training, as far as we are aware, none had completed the College of Optometrists Diploma in Glaucoma and the hospital-based optometrists were working alongside the consultant ophthalmologist who was responsible for the patients. In contrast, the OLGA service runs independently and Eye referrals are accepted from both glaucoma-and nonglaucoma-specialist consultant ophthalmologists who, at the time of the study, numbered 3 and 12, respectively.…”

“…4,[9][10][11] It has been shown that specially trained community optometrists are able to make satisfactory decisions regarding the diagnosis and initiation of treatment for glaucoma 8 and can help to reduce the number of false positive referrals into the Hospital Eye Service (HES) by up to 53%. [5][6][7] However, there remains a large number of individuals considered to be at risk of developing glaucoma who are still being monitored within the HES and, once a diagnosis of glaucoma is confirmed, follow-up becomes lifelong.…”

“…Although we acknowledge that our patient numbers are small compared with the majority of the previous studies, 4,9-11 all but one of these studies 4,10,11 required the ophthalmologists to make decisions based on a retrospective review of clinical data that had been collected by other health professionals. By adopting a similar methodology, it would have been possible to include a larger number of patients and provide a quantifiable measure of agreement between the two ophthalmologists-an advantage of the Banes study.…”

Comparative analysis of delivery of primary eye care in three European countries

“…Table 22 lists relevant studies, including the German one on glaucoma screening. Studies on the quality of glaucoma related care Syam et al [2010] The Petersborough scheme for community specialist optometrists in glaucoma: a feasibility study Uihlein, Dietze [2009] Zur Verlässlichkeit des Glaukomscreenings durch den Augenoptiker/Optometristen, Teil 2 Azuara-Blanco et al [2007] The accuracy of accredited glaucoma optometrists in the diagnosis and treatment recommendation for glaucoma Bowling et al [2005] Outcomes of referrals by community optometrists to a hospital glaucoma service Gray et al [2000] The Bristol shared care glacuoma study: outcome at follow up at 2 years Spry et al [1999] The Bristol Shared Care Glaucoma Study: reliability of community optometric and hospital eye service test measures Gray et al [1997] The Bristol shared care glaucoma study -validity of measurements and patient satisfaction Source: Institute for Health Care Management and Research Syam et al [2010] analysed the role of community optometrists specifically trained with regard to glaucoma in the area of Peterborough (UK) who were both refining glaucoma referrals to the Hospital Eye Service (HES) and providing follow up to stable glaucoma patients. In about 2 years, the 10 optometrists involved saw 1,184 patients on whom they carried out a systematic ophthalmic examination.…”