Outcomes of referrals by community optometrists to a hospital glaucoma service

Bowling, Brad

doi:10.1136/bjo.2004.064378

Cited by 95 publications

(133 citation statements)

References 15 publications

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“…This emphasises the need for continuous training and regular feedback for any ophthalmic paramedic involved in glaucoma screening. The low positive predictive value (PPV; 52.7, 95% CI ¼ 44.3-58.3%) of the glaucoma suspects in the community setting is similar to the study by Bowling et al 28 in which nearly half (45.8%) of the patients referred from community primary care sources were discharged from ophthalmological review. The low PPV can result in a large number of unnecessary referrals from the ophthalmic assistants to the hospital services.…”

Section: Discussionsupporting

confidence: 49%

Evaluation of the effectiveness of ophthalmic assistants as screeners for glaucoma in North India

Sinha¹,

Astbury

2011

Eye

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Aim To assess whether ophthalmic assistants are effective in screening people for glaucoma in India. Methodology The study subjects were examined by both trained ophthalmic assistants and an ophthalmologist in both hospital and community settings. Specific tests for the diagnosis of glaucoma suspects included visual field examination using frequency doubling technology perimetry, intraocular pressure measurement (Tonopen), A-scan central anterior chamber depth measurement and dilated optic disc examination. The findings recorded by the ophthalmic assistants were masked to the ophthalmologist to avoid measurement bias. Results In the hospital setting, there was a substantial level of agreement between the ophthalmic assistants and the ophthalmologist in the diagnosis of glaucoma suspects (89.29%, k ¼ 0.7, 95% confidence interval (CI) ¼ 0.54-0.86). The diagnostic accuracy of the ophthalmic assistants in detecting glaucoma suspects was high for sensitivity (95.2%, 95% CI ¼ 91.4-97.7%) but lower for specificity at 71.4% (95% CI ¼ 60.0-78.7%). In the community setting, there was a moderate level of agreement between the ophthalmic assistants and the ophthalmologist in the diagnosis of glaucoma suspects (78.23%, k ¼ 0.50, 95% CI ¼ 0.37-0.64). The diagnostic accuracy of the ophthalmic assistants in detecting glaucoma suspects was moderate for sensitivity (82.9, 95% CI ¼ 69.7-91.5%) but lower for specificity at 76.8% (95% CI ¼ 72.7-79.5%). Conclusion Ophthalmic assistants can be used for opportunistic case detection of glaucoma suspects in the community. Structured training of the ophthalmic assistants together with enhanced clinical experience would improve their performance in detecting glaucoma suspects in the community.

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Section: Discussionsupporting

confidence: 49%

Evaluation of the effectiveness of ophthalmic assistants as screeners for glaucoma in North India

Sinha¹,

Astbury

2011

Eye

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“…2,[4][5][6] In these studies, the false-positive rate was as high as 57%, with up to 45% discharged from the HES at the first visit. 2,4,5 Patients with confirmed glaucomatous damage only made up approximately 17-20% of the optometrist referrals. 2,4,5 Up to 12% of optometrist referrals were made for isolated VF loss in the absence of any glaucoma damage.…”

Section: Discussionmentioning

confidence: 93%

“…2,4,5 Patients with confirmed glaucomatous damage only made up approximately 17-20% of the optometrist referrals. 2,4,5 Up to 12% of optometrist referrals were made for isolated VF loss in the absence of any glaucoma damage. 7,8 A separate study reported an increase in false-positive referrals from 1988 to 1993, and this was felt to be due to the increase in VF testing and to an increased willingness to refer patients at lower IOPs.…”

Section: Discussionmentioning

confidence: 99%

The influence of the new general ophthalmic services (GOS) contract in optometrist referrals for glaucoma in Scotland

Ang

Azuara‐Blanco

2007

Eye

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“…Seven reports provided information on the accuracy of referrals by community-based optometrists for people with suspected glaucoma. [287][288][289][290][291][292][293] However, no studies were identified that reported the diagnostic accuracy of the test strategy of community optometrists or glaucoma-trained optometrists, or included sufficient data to produce a 2 × 2 table to calculate sensitivity and specificity. Sensitivity and specificity for optometrist testing were derived from Tuck.…”

Section: Probabilitiesmentioning

confidence: 99%

The clinical effectiveness and cost-effectiveness of screening for open angle glaucoma: a systematic review and economic evaluation

Burr¹,

Mowatt²,

Hernández³

et al. 2007

Health Technol Assess

330

380

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Outcomes of referrals by community optometrists to a hospital glaucoma service

Cited by 95 publications

References 15 publications

Evaluation of the effectiveness of ophthalmic assistants as screeners for glaucoma in North India

Evaluation of the effectiveness of ophthalmic assistants as screeners for glaucoma in North India

The influence of the new general ophthalmic services (GOS) contract in optometrist referrals for glaucoma in Scotland

The clinical effectiveness and cost-effectiveness of screening for open angle glaucoma: a systematic review and economic evaluation

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