Glaucoma in optometric practice: a survey of optometrists

Purpose: Questionnaires are commonly used as a proxy measure of clinical practice; however their application in a variety of healthcare settings has found significant self-reporting bias. The aim of this study is to estimate the validity of self-reporting as a measure of optometrist case-finding practice for glaucoma and the appropriate referral of suspects. Methods: Two complementary approaches were used: (1) a sample of optometrists (N = 34) on an ophthalmic list in West London were visited incognito by Standardised Patient (SP) volunteers aged over 54 who were trained to identify the components of a standard Sight Test. Optometrists from the same list were then invited to participate in a structured face-to-face interview regarding their case finding practice for glaucoma. The findings from the two sources were compared. (2) as part of a national glaucoma survey of optometrists, respondents (N = 1264) were asked in a free text question for the information that they would include in a referral letter for suspect glaucoma. The responses were compared to the content of a sample of glaucoma referral letters (N = 571) obtained from consultant ophthalmologists across the UK. In each case, the degree of correspondence ('match') between reported practice and actual practice was assessed by chi-square analysis. Results: For the SP study there was incomplete correspondence between the questionnaire and SP reports in several areas e.g. questions relating to a complete history and symptoms, measurement of intra-ocular pressure and visual fields. Complete correspondence was found for questions asking about the routine assessment of ocular health and refraction. For the referral study, correspondence between survey findings and referral letters was obtained for IOP only. No correspondence was found for disc assessment, visual fields or family history of glaucoma. Conclusions: The overall findings from both studies indicate that self-reported clinical practice questionnaires overestimate routine tests undertaken by optometrists in practice. Although there was a good correspondence for mandatory tests, correspondence was poor for discretionary tests. These findings should be borne in mind in all questionnaire studies that report current practice in glaucoma case-finding.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Does optometrists’ self‐reported practice in glaucoma detection predict actual practice as determined by standardised patients?

Theodossiades

Myint

Murdoch

et al. 2012

“…This finding is consistent with previous clinical practice surveys. 8,18 Non-contact tonometry gained popularity in optometric practice during the 1980s. It had obvious advantages as a screening test for glaucoma: the test was quick and easy to perform, did not require anaesthetic eyedrops, was acceptable to patients and could be delegated to optical assistants.…”

Section: Iop Measurementmentioning

confidence: 99%

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

Myint

Edgar

Kotecha

et al. 2011

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.

“…9,10 Tonometry Contact tonometry is used in hospital clinics for measuring IOP while non-contact tonometry (NCT) is most commonly used by UK optometrists in community practice. 11,12 Contact tonometry is considered the most accurate method, with one technique, Goldmann Applanation Tonometry (GAT), regarded as the 'gold standard'. NCT tends to be preferred in community optometric practice because it can be delegated to trained but non-optometrically qualified staff.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the effectiveness of two enhanced glaucoma referral schemes

Parkins¹,

Edgar

2011

Purpose: To compare the clinical and financial effectiveness of two optometricled enhanced glaucoma referral schemes in the Bexley Care Trust area. Methods: Over a 12-month period all suspect glaucoma/Ocular Hypertension (OHT) referrals from optometrists relating to patients registered with Bexley GPs were analysed. All these patients were examined under one of two schemes. One was an enhanced glaucoma repeat measurement (EGRM) scheme in which the referring optometrist conducted the repeated tests him/herself prior to referral or non-referral. The alternative was a refinement pathway (RCAS) using a small team of accredited community optometrists. Results: During the full year commencing April 2007, repeat measures using the EGRM scheme resulted in 76% of patients not being referred. In 44.5% of all EGRM patients, where raised intraocular pressure (IOP) was found by noncontact tonometry (NCT), repeated measurement by Goldmann/Perkins applanation tonometry resulted in readings that were <22 mmHg, or that had less than a 5 mmHg difference between the two eyes. Financial review demonstrated that the EGRM achieved 62% savings when compared with HES tariff while RCAS resulted in a saving of 3.5%. Conclusions: Using a primary care repeat measurement scheme to support referral decision-making demonstrated substantial cost benefit while onward referral for refinement by accredited optometrists was essentially cost-neutral compared with HES tariff. Local schemes foster fragmentation and consideration should be given to a service which covers a large population area.