An analysis of referral routes and diagnostic accuracy in cases of suspected glaucoma

Sheldrick, J H; Ng, Chester; Austin, David; Rosenthal, A R

doi:10.3109/09286589409071443

Cited by 72 publications

(64 citation statements)

References 10 publications

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“…9,10 A previous study has shown that 90% of patients with glaucoma are referred to the hospitals on the basis of abnormal findings by optometrists. 26 Most people would require change of spectacles or reading glasses from about the age of 40 years, which incidentally is also about the age glaucoma incidence appears significant. In the UK, the optometrist plays an important role in glaucoma detection, while in Ghana there are only few optometrists and their role in glaucoma referrals at the present time is fairly limited.In both Korle-Bu Teaching and Trust Hospitals referrals are usually from mass screening exercises by ophthalmic nurses providing outreach services or attached to other hospitals and clinics where there are no ophthalmologists, and also employers for routine medical examination.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of risk factors for advanced glaucoma in Ghanaian patients

Ntim-Amponsah

Amoaku

Ewusi

et al. 2004

Eye

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Purpose This study was to determine factors associated with individuals presenting late with advanced glaucomatous optic nerve damage. Methods A case-control study recruiting 123 patients with early features of primary open angle glaucoma (control) and 93 patients with advanced glaucoma (cases) was carried out for risk-factor analysis. Exposures of interest included those already established as major risk factors for glaucoma. These were initial intraocular pressure (IOP), age, and family history. In addition, occupation, ethnic origin, history of diagnosis of diabetes mellitus, hypertension, sickle cell disease, and previous eye examination were of interest. Results Univariate analysis showed that initial IOP431 mmHg, age of 4 60 years, absence of family history of glaucoma, occupational grouping, ethnicity, and male sex were associated with advanced glaucoma at presentation. Adjusted odds ratio or by multiple logistic regression model showed that initial IOP431 mmHg in a patient was more likely to present with advanced glaucoma (OR 2.66, 95% confidence interval (CI) 1.45, 4.91; P-value 0.0017) than lower pressures. Patients aged 60-69 years (OR 2.53, 95% CI 1.01, 6.31; P-value 0.0473) and 70-90 years (OR 5.16, 95% CI 1.97, 13.51; P-value 0.0008) were more likely to present with advanced glaucoma than younger ones Conclusions Subjects with initial IOP431 mmHg were nearly three times more likely to present with advanced glaucoma than those with IOPo32 mmHg. Subjects over the age of 60 years were more than two times likely to present with advanced glaucoma than younger subjects.

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Section: Discussionmentioning

confidence: 99%

Evaluation of risk factors for advanced glaucoma in Ghanaian patients

Ntim-Amponsah

Amoaku

Ewusi

et al. 2004

Eye

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“…There is no formal screening programme for glaucoma in the UK, so detection is largely dependent on the public attending an optometrist for sight testing, with optometrists responsible for over 90% of referrals to the Hospital Eye Service. [5][6][7][8] Three tests/examinations are recommended for the detection of glaucoma; measurement of IOP, visual field and optic disc assessment. However, optometrist case-finding and referral criteria vary considerably across the profession.…”

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confidence: 99%

“…11 Recent studies have reported positive predictive values (PPV) of optometrist referrals for glaucoma ranging between 0.31 and 0.50. 5,7,9,[11][12][13][14] As PPV is directly related to prevalence and prevalence is low, this figure implies that optometrist referrals have a high degree of specificity. 15 The proportion of undetected glaucoma in the developed world, however, remains at about 50%.…”

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confidence: 99%

Glaucoma case finding: a cluster-randomised intervention trial

Theodossiades

Murdoch

2004

Eye

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Purpose To assess the effect of an intervention comprising training in optic disc assessment, explicit referral criteria and ophthalmologist feedback on referred patients, on the number of optometrist referrals for suspected glaucoma seen at a referral site and the positive predictive value of those referrals. Methods Optometric practices routinely referring to the Ealing Hospital Eye Clinic were randomly divided into two groups taking into consideration those practices, which shared an optometrist (a cluster) and the number of optometrist days worked per week. One group of practices acted as controls, while the other practices were invited to receive the intervention. Data on 397 new patients referred and presenting to Ealing Hospital with suspected glaucoma were collected over a 20-month period. The data on patients who had failed to attend their appointment were collected over 7 months of this period. The number of referrals seen, the positive predictive value of those referrals, and the attendance rate were calculated. Optometrist's opinions of the intervention were assessed qualitatively. Data relating to optometrist compliance with the intervention were also collected. Results The number of glaucoma referrals presenting to Ealing Hospital from the intervention practices was almost double that from the control practices (210 vs 119). When cluster randomisation, the number of optometrist days per cluster and the number of assessed referrals in the preintervention period are taken into consideration, it is estimated that the intervention is associated with a 52% increase in the number of referrals reaching Ealing Hospital. However, the design effect resulting from the cluster randomisation was unexpectedly high (of the order of [13][14] and so the confidence intervals around the estimate of 52% are very wide (95% c.i. 35% decrease to 253% increase, P ¼ 0.34). There was no evidence of an association between optometrist compliance with the intervention and the number of referrals seen at Ealing Hospital. The positive predictive value (PPV) of referrals was similar for the intervention (0.49 (95% c.i. 0.42, 0.55)) and control groups (0.46 (95% c.i. 0.33, 0.60)). Optometrist opinions of the intervention were largely favourable. All expressed a willingness to participate in future programmes. Conclusion A large difference in the number of referrals between the practice groups was observed. Since the PPV of referral was unchanged, the potential impact of the intervention in terms of numbers of new cases of glaucoma detected in the community is substantial. However, because of its large design effect, this trial does not provide conclusive evidence of an impact of the intervention on referral numbers. A considerably larger trial will be required to produce conclusive evidence of an effect.

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“…Between 10-33% of glaucoma patients present with advanced glaucoma, [1][2][3][4][5][6] this is a risk factor for blindness. 3,5,[7][8][9] Reduction in intraocular pressure is the only treatable risk factor for glaucoma and may be achieved by either medical or surgical intervention.…”

Section: Introductionmentioning

confidence: 99%

The willingness of patients presenting with advanced glaucoma to participate in a trial comparing primary medical vs primary surgical treatment

Leighton

Lonsdale

Tildsley

et al. 2011

Eye

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Aim The aim of this study is to examine the attitudes of patients, who presented with advanced glaucoma in at least one eye, to participation in a randomised prospective trial comparing primary medical treatment with primary surgical treatment for advanced glaucoma. Methods Patients who had presented with advanced glaucoma (415 dB loss mean deviation on Humphrey visual field testing) in at least one eye were asked to participate. Five focus groups comprising of 4-8 patients and consisting of 29 patients in total were undertaken. The group interviews were conducted by two experienced qualitative researchers, an ophthalmic clinician was present to clarify technical issues. The focus group discussions were taped and transcribed in full, and analysed through a process of familiarisation, open (inductive) coding, theme generation, theme refinement, and thematic mapping. Results Three overarching themes were identified: (1) the extent of patients' knowledge, (2) anxieties about surgery, and (3) concerns about compromised care due to trial involvement; these themes were further classified into eight sub-themes. Conclusions Patients' willingness to participate in randomised clinical studies is significantly connected to their level of comprehension and insight about the medical condition, its treatment, and the research process; misunderstandings about any of these aspects may act as a significant barrier to trial recruitment. Recruitment rates for future randomised trials may be enhanced by ensuring that patients have full and accurate information about the treatment alternatives, and that uncertainty exists for best patient outcomes between treatment options, and reassuring potential participants that the research process, in particular randomisation, will not compromise clinical care.

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An analysis of referral routes and diagnostic accuracy in cases of suspected glaucoma

Cited by 72 publications

References 10 publications

Evaluation of risk factors for advanced glaucoma in Ghanaian patients

Evaluation of risk factors for advanced glaucoma in Ghanaian patients

Glaucoma case finding: a cluster-randomised intervention trial

The willingness of patients presenting with advanced glaucoma to participate in a trial comparing primary medical vs primary surgical treatment

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