A national survey of diagnostic tests reported by UK community optometrists for the detection of chronic open angle glaucoma

Abstract

Purpose: In the UK, the majority of cases of chronic open angle glaucoma are detected by community optometrists following a routine sight test. However, there is potential for variability in case finding strategies used. The aim of this study was to carry out a national web-based survey to determine current diagnostic tests used by optometrists in glaucoma case finding. Methods: Optometrists on the Association of Optometrists (AOP) electronic database were invited to participate. The survey was open for 16 weeks between April and July 2008. Results: A total of 1875 optometrists were eligible to enter the survey, of which 1264 answered the questions relating to diagnostic equipment. Respondents were asked to indicate their usual method of examining the optic nerve head. Direct ophthalmoscopy only was used by 25% with the majority (62%) using a combination of direct and slit-lamp binocular indirect methods. The vast majority of optometrists (78%) used non-contact tonometry to measure intraocular pressure, with only 16% routinely using a Goldmann or Perkins applanation tonometer. The perimeter most frequently used was either one of the Henson range of instruments (39%) or the Humphrey Field Analyser (22%). A smaller number of optometrists (<5%) had access to more specialised imaging equipment, such as HRT, GDx or OCT. Conclusions: The results of the survey demonstrate that UK optometrists are well equipped to carry out case finding for chronic open angle glaucoma, although there is a lack of standardisation with respect to equipment used.

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

“…Typically, a non-OSI will not dilate the pupil to perform an examination of the optic disc, whereas the OSI and consultant would always dilate the pupil except in the presence of an occludable anterior chamber angle. By way of a national survey of UK community optometrists, Myint et al reported that 25% of optometrists used direct ophthalmoscopy alone and a further 62% used a combination of direct ophthalmoscopy and slit-lamp binocular indirect ophthalmoscopy, whereas the OSI or consultant in the CHANGES scheme only used slit-lamp binocular indirect techniques 3. A difference in the method used for measuring IOP also exists, with the OSI and consultant solely using Goldmann applanation tonometry.…”

“…Raised intraocular pressure (IOP) is an important risk factor for glaucoma and hence the importance of also performing this measurement in primary care. Measuring the IOP with Goldmann or Perkins tonometry and slit-lamp binocular indirect ophthalmoscopy of the optic disc are core competencies of an optometrist's training, although in day-to-day clinical practice these examination techniques are often not used by community optometrists as part of a routine eye examination 2 3. The published literature also reports a range in the agreement of examination and management between optometrists and ophthalmologists 4–8…”

Developing standards for the development of glaucoma virtual clinics using a modified Delphi approach

“…Predictions estimate that the UK population will reach approximately 72 million by 2031, with those over the age of 55 years comprising over 33% of the population 1. Glaucoma increases in prevalence with advancing age,2 and this, combined with the increasing use of newer diagnostic technologies by primary care providers3 as well as changes in referral behaviour,4 5 has resulted in an increase in the number of new glaucoma suspect referrals to secondary NHS care. The chronicity of glaucoma means that once diagnosed, the patient requires lifelong NHS hospital eye service (HES) care.…”

Avoidable sight loss from glaucoma: is it unavoidable?

“…Due to the prevalence of the disease and methods of detection, general population screening programmes are difficult to implement and are not cost-effective, although targeted screening programmes have been suggested 3. In the UK, the majority of POAG cases are detected through opportunistic case finding by community optometrists 4. If the optometrist suspects glaucoma, patients are referred through the National Health Service (NHS) to their local hospital eye service (HES) to confirm diagnosis and commence treatment.…”