Glaucoma detection: the content of optometric eye examinations for a presbyopic patient of African racial descent

Shah, Rakhee; Edgar, David F; Spry, Paul G.; Harper, Robert A.; Kotecha, Aachal; Rughani, Sonal; Evans, Bruce J. W.

doi:10.1136/bjo.2008.145623

Cited by 20 publications

(51 citation statements)

References 22 publications

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“…In our optometry cohort, 96% performed gonioscopy, which is much higher than stated in previous community optometry studies (ranging from 0-53%). 15,16 This may be explained by the fact that the hospital-based optometrists in this scheme are fully trained in gonioscopy, which is less common for community optometrists. Similarly, the results for visual field testing were much higher in our study as compared with a previous study looking at community optometrists.…”

Section: Discussionmentioning

confidence: 99%

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Patterns of adherence to NICE Glaucoma Guidance in two different service delivery models

Chawla

Patel

Yuen

et al. 2012

Eye

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Purpose To assess adherence patterns to the UK National Institute of Health and Clinical Excellence (NICE) guidelines on glaucoma management (2009) in a tertiary referral centre shared care setting and in a district general hospital (DGH) setting. Method We performed a retrospective case note analysis of 200 patients from two centres between January and June 2010. The two centres involved were a consultant-guided teaching hospital optometry-led shared care setting (setting 1) and a consultant-led DGH clinic setting (setting 2). The main outcome measures were compliance with eight of the main NICE guidelines on glaucoma diagnosis and management (2009). Results Both centres showed good adherence to the guidelines regarding the choice of initial treatment (96% vs 100%, settings 1 and 2, respectively) and arranging appropriate monitoring intervals (92% vs 86%). However, significant differences were seen when assessing whether an optic disc image was obtained at the initial visit (74% vs 10%), whether an appropriate initial assessment was performed (96% vs 58%), whether patients' review interval complied with the NICE guidance regardless of hospital cancellations (92% vs 66%), and whether concordance with medication was checked (88% vs 24%) (settings 1 and 2, respectively, Po0.01-Fisher's exact test). Conclusion Our study provides evidence to suggest that a hospital-based shared care service with trained optometrists using assessment sheets compares favourably to non-specialist glaucoma care delivered by ophthalmologists.

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Section: Discussionmentioning

confidence: 99%

“…Similarly, the results for visual field testing were much higher in our study as compared with a previous study looking at community optometrists. 15 Such improvements are encouraging and may reflect the impact of the NICE guidance and improved knowledge and education.…”

Section: Discussionmentioning

confidence: 99%

Patterns of adherence to NICE Glaucoma Guidance in two different service delivery models

Chawla

Patel

Yuen

et al. 2012

Eye

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“…The quality of this optometric core services in general is addressed in some of the studies found (see Table 21) and should be dealt with briefly, before then proceeding with the studies relating to single conditions. Studies on the quality of optometric eye examinations Shah et al [2008] The content of optometric eye examinations for a young myope with headaches Shah et al [2009a] Glaucoma detection: the content of optometric eye examinations for a presbyobic patient of African racial descent Shah et al [2009b] The content of optometric eye examinations for a presbyopic patient presenting with symptome of flashing lights…”

Section: Criterion 6: Quality Of Care (I) Objectives and Methodsmentioning

confidence: 99%

“…At least half of the questions were asked by 22 % of the practitioners. The second scenario [Shah et al 2009a] provided for a 44-year-old presbyopic patient of African racial origin, a patient group considered at risk of primary open angle glaucoma (POAG), complaining of recent difficulties with her near vision. Tonometry and optic disc assessment were carried out by 95 % of the optometrists who thereby complied with the advice from the College of Optometrists that at least two of the three tests tonometry, optic disc assessment and visual field assessment should be performed on patients aged over 40 years.…”

Section: Source: Institute For Health Care Management and Researchmentioning

confidence: 99%

“…The checklists based on expert panels' opinions and information from evidence-based reviews and clinical guidelines [Shah et al 2009c]. One of the aims of this study was the evaluation of the appropriateness of the eye examinations carried out for the presented patient [Shah et al 2008;Shah et al 2009a;Shah et al 2009b]. …”

Section: Source: Institute For Health Care Management and Researchmentioning

confidence: 99%

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

Jahn¹,

Thomas²,

Weegen³

et al. 2011

Gesundheitswesen

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Design and use of vignettes to investigate referral decision-making by optometrists

Parkins

Shah

Benwell

et al. 2021

Journal of Optometry

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Purpose This study describes the design and application of a range of online clinical vignettes for measuring the impact of Continuing Education and Training (CET) and identifying unwarranted variation in optometric decision-making concerning referrals to secondary care. Methods Twenty computerised vignettes were developed to assess clinical and referral management decisions taken in primary care optometry. The online system was specifically designed to present vignettes (ten pre-CET and ten post-CET) that avoided prompting correct answers. The main study group was qualified optometrists (N = 31) who chose any CET options available to United Kingdom optometrists over six months. Participants submitted a record of the CET undertaken, which was compared with an anonymised General Optical Council (GOC) reference sample. The vignettes were also completed by newly-qualified (N = 18) and pre-registration (N = 11) groups. Results CET had no significant correlation ( p = 0.37) with improvement in optometric clinical decision-making and referral practice (qualified group). Selection bias affected this group who had more CET points ( p = 0.008) and peer discussion points ( p = 0.003) than the GOC reference sample. Results were indicative due to small sample sizes. Newly-qualified practitioners were significantly more likely to refer than the qualified group ( p = 0.004). Number of referrals decreased with time since qualification ( p = 0.006). Conclusion Computerised vignettes are a useful tool for comparing referral decisions between groups. Recruiting clinicians for time-consuming vignette studies is challenging. Strategies to reduce unwarranted variation in optometry, including support for newly-qualified optometrists, require further investigation.

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Glaucoma detection: the content of optometric eye examinations for a presbyopic patient of African racial descent

Cited by 20 publications

References 22 publications

Patterns of adherence to NICE Glaucoma Guidance in two different service delivery models

Patterns of adherence to NICE Glaucoma Guidance in two different service delivery models

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

Design and use of vignettes to investigate referral decision-making by optometrists

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