Clinical outcomes of the Centre for Eye Health: an intra-professional optometry-led collaborative eye care clinic in Australia

Wang, Henrietta; Kalloniatis, Michael

doi:10.1080/08164622.2021.1878821

Cited by 34 publications

(34 citation statements)

References 66 publications

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“…As per the clinical protocols of the Centre for Eye Health, the diagnosis was made by one examining clinician and by a remote review by another clinician. 16 For the patients with glaucoma, we selected the eye with the worse stage of glaucoma; for non-glaucoma patients, we randomly selected one eye for inclusion. Our goal was to focus on patients with early to moderate glaucoma due to the nature of the clinic from which patient data were derived, which limited the number of cases of advanced glaucoma included in the present study (defined as a mean deviation score worse than −12 dB).…”

Section: Methodsmentioning

confidence: 99%

The Frontloading Fields Study (FFS): Detecting Changes in Mean Deviation in Glaucoma Using Multiple Visual Field Tests Per Clinical Visit

Phu

Kalloniatis

2021

Trans. Vis. Sci. Tech.

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Purpose To determine the impact of different numbers of visual field tests per visit for detecting mean deviation changes over time in patients with early glaucoma or suspected glaucoma and to identify a practical approach to maximize change detection. Methods Intrasession ( n = 322) and intersession ( n = 323) visual field results for patients with glaucoma or suspected glaucoma were used to model mean deviation change in 10,000 progressing and 10,000 non-progressing computer-simulated patients over time. Variables assessed in the model included follow-up intervals (0.5, 1, or 2 years), reliability rates (70%, 85%, or 100%) and number of visual field tests performed at each visit (one to four). Results Two visual field tests per session compared with one provided higher case detection rates at 2 years (99%–99.8% vs. 34.7%–76.3%, respectively), reduced time to detection (three or four visits vs. six to 10, respectively), and more positive mean deviation score (−4 dB vs. −10 dB, respectively) at the point of mean deviation change identification, especially in the context of unreliable results. Performing two tests per visit offered similar advantages compared with more tests. False positive change detection rates (<2.5%), were similar across all conditions. Patients followed up 6 monthly had less severe mean deviation loss at follow-up compared to 1-year and 2-year follow-up intervals. Conclusions Performing two tests per clinical visit at 6 months is practical using SITA-Faster and provides higher detection rates of mean deviation change in comparison with only one test performed per visit and more spaced-out intervals. Translational Relevance This model provides guidance for selecting the number of tests per visit to detect mean deviation change.

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Section: Methodsmentioning

confidence: 99%

The Frontloading Fields Study (FFS): Detecting Changes in Mean Deviation in Glaucoma Using Multiple Visual Field Tests Per Clinical Visit

Phu

Kalloniatis

2021

Trans. Vis. Sci. Tech.

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“…CFEH is a referral-only clinic providing advanced ocular diagnostic testing and disease management by specially trained optometrists and ophthalmologists. 38 All participants in this study provided prior written informed consent to use of their de-identified data for research in accordance with the Declaration of Helsinki and approved by the Biomedical Human Research Ethics Advisory Panel of the University of New South Wales.…”

Section: Methodsmentioning

confidence: 99%

Location-Specific Thickness Patterns in Intermediate Age-Related Macular Degeneration Reveals Anatomical Differences in Multiple Retinal Layers

Trinh

Khou

Kalloniatis

et al. 2021

Invest. Ophthalmol. Vis. Sci.

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Purpose To examine individual retinal layers’ location-specific patterns of thicknesses in intermediate age-related macular degeneration (iAMD) using optical coherence tomography (OCT). Methods OCT macular cube scans were retrospectively acquired from 84 iAMD eyes of 84 participants and 84 normal eyes of 84 participants propensity-score matched on age, sex, and spherical equivalent refraction. Thicknesses of the retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer + Henle's fiber layer (ONL +HFL ), inner- and outer-segment layers (IS/OS), and retinal pigment epithelium to Bruch's membrane (RPE-BM) were calculated across an 8 × 8 grid (total 24° × 24° area). Location-specific analysis was performed using cluster (normal) and grid (iAMD) -to-cluster (normal) comparisons. Results In iAMD versus normal eyes, the central RPE-BM was thickened (mean difference ± SEM up to 27.45% ± 7.48%, P < 0.001; up to 7.6 SD-from-normal), whereas there was thinned outer (OPL, ONL +HFL , and non-central RPE-BM, up to −6.76% ± 2.47%, P < 0.001; up to −1.6 SD-from-normal) and inner retina (GCL and IPL, up to −4.83% ± 1.56%, P < 0.01; up to −1.7 SD-from-normal) with eccentricity-based effects. Interlayer correlations were greater against the ONL +HFL (mean |r| ± SEM 0.19 ± 0.03, P = 0.14 to < 0.0001) than the RPE-BM (0.09 ± 0, P = 0.72 to < 0.0001). Conclusions Location-specific analysis suggests altered retinal anatomy between iAMD and normal eyes. These data could direct clinical diagnosis and monitoring of AMD toward targeted locations.

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“… 21 – 23 The clinic receives referrals predominantly from community optometrists working in primary care; thus, the cohort of patients seen within the glaucoma service largely represents patients who are deemed at risk of glaucoma requiring further assessment and management (see below for more details regarding the model of care). 24 …”

Section: Methodsmentioning

confidence: 99%

“…The model of care at the Centre for Eye Health notably differs from routine primary eye care and may also be different from other models of glaucoma service at the intermediate and tertiary level; indeed, it was the first of its kind in Australia. 24 The scope of practice within the clinic specifically focuses on the assessment of patients with borderline, suspected, or early stages of chronic eye disease such as glaucoma; thus, its patients are ideal for examining a cohort of patients at risk of developing glaucoma. 24 Specifically, the higher risk nature of the patients seen in the clinic means that the diagnosis rates of glaucoma are expectedly higher compared to rates obtained from community practice (our previous study 11 on consecutively referred patients found that approximately 14% received a diagnosis of glaucoma).…”

Section: Methodsmentioning

confidence: 99%

Glaucoma Suspects: The Impact of Risk Factor-Driven Review Periods on Clinical Load, Diagnoses, and Healthcare Costs

Phu

Masselos

Sullivan-Mee³

et al. 2022

Trans. Vis. Sci. Tech.

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Purpose To model the healthcare impact (clinical attendance time and financial cost) and clinical outcomes (glaucoma diagnoses) of different risk factor–driven review frequencies for glaucoma suspect patients up until the point of discharge or diagnosis. Methods Medical records of 494 glaucoma suspects were examined to extract the clinical diagnosis. Two criteria for review periods were defined, based on contrasting stringency from established clinical guidelines: American Academy of Ophthalmology (AAO), more stringent/less frequent; and the Australian National Health and Medical Research Council (NHMRC), less stringent/more frequent. We used these data to model patient outcomes and healthcare costs using a Markov model. Results The less stringent/more frequent criterion resulted in more high-risk glaucoma suspects requiring more frequent review compared with the more stringent/less frequent criterion. Across the 15 Markov cycles (7.5 years), the less stringent/more frequent review criterion resulted in 6.6% more diagnoses and fewer overall clinical visits (14.7%) and reduced cost per diagnosis by 12% to 32% ( P < 0.0001). The number of glaucoma diagnoses made using each criterion converged at 2.5 to 3 years. Conclusions The stringency of risk assessments for glaucoma suspects impacts review periods and therefore clinical load, healthcare costs, and diagnosis rates. Using current testing methods, more frequent review periods appear advantageous for diagnostic efficiency, with both lower clinic load and lower cost up until the point of discharge or glaucoma diagnosis. Translational Relevance A less stringent criterion for assessing the risk of developing glaucoma potentially offers a more cost-effective method for reviewing glaucoma suspects, especially within the first 2.5 years.

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Clinical outcomes of the Centre for Eye Health: an intra-professional optometry-led collaborative eye care clinic in Australia

Cited by 34 publications

References 66 publications

The Frontloading Fields Study (FFS): Detecting Changes in Mean Deviation in Glaucoma Using Multiple Visual Field Tests Per Clinical Visit

The Frontloading Fields Study (FFS): Detecting Changes in Mean Deviation in Glaucoma Using Multiple Visual Field Tests Per Clinical Visit

Location-Specific Thickness Patterns in Intermediate Age-Related Macular Degeneration Reveals Anatomical Differences in Multiple Retinal Layers

Glaucoma Suspects: The Impact of Risk Factor-Driven Review Periods on Clinical Load, Diagnoses, and Healthcare Costs

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