Prevalent practice patterns in glaucoma: Poll of Indian ophthalmologists at a national conference

Abstract

Purpose:The aim of this study is to explore and compare the prevailing practice patterns in the diagnosis and management of glaucoma among subspecialists and general ophthalmologists in India.Materials and Methods:This is an interactive audience response system (ARS) based poll of ophthalmologists attending the annual conference of the Glaucoma Society of India in 2013.Results:The information was obtained from 379 ophthalmologists (146 glaucoma specialists, 54 nonglaucoma subspecialists, and 179 general ophthalmologists). The majority of polled ophthalmologists (236; 62%) had 10 or more years of experience in ophthalmology. The glaucoma specialists differed from nonglaucomatologists in their preference for Goldmann applanation tonometer (P < 0.01), four-mirror gonioscope (P < 0.01), Humphrey perimeter (P < 0.01), laser peripheral iridotomy in primary angle closure disease (P = 0.03), postiridotomy gonioscopy (P < 0.01), and usage of antifibrotic agents during filtering surgery (P < 0.01). Optical coherence tomography was the most preferred imaging modality and was utilized more often by the subspecialists than general ophthalmologists. The ophthalmologists also differed in their choice of antiglaucoma medications. More glaucoma specialists were performing surgery on children with congenital glaucoma (P < 0.01), implanting glaucoma drainage devices (P < 0.01), and using scientific journals to upgrade knowledge (P = 0.03) than the other ophthalmologists.Conclusions:This poll is the first of its kind in India, in its usage of the ARS, and in comparing the practice patterns of care for glaucoma among subspecialists and general ophthalmologists. It has revealed substantial diversity in a few areas among those who did and did not receive specialty training in glaucoma.

Bridging gaps in ophthalmology residency programs: the link between practice, training and confidence in ocular examination and gonioscopy for diagnosing glaucoma, a blinding disease

“…Based upon the findings of our survey, only 66.9% of the responding ophthalmologists routinely perform gonioscopy when indicated, and one-fourth of them are GS. This result agrees with published surveys conducted worldwide, which indicate that 46–80% of the qualified ophthalmologists perform routine gonioscopy, the highest percentage being reported from Singapore, likely due to their high incidence of AACG [ 14 – 22 ]. Documentation of gonioscopy among residents in the USA was reported to be as high as 76.8% in 2005 [ 19 ] but as low as 46% one decade later at another center [ 20 ].…”

Diagnosis of Pseudoexfoliation Syndrome in Pseudophakic Patients

“…Unfortunately, however, while gonioscopy remains the gold standard, its limitations are well established: it is subjective, highly dependent on the examiner’s skills, requires patient cooperation, and is associated with limited interobserver agreement. Furthermore, its rate of use among general ophthalmologists is low [18-21]. Although general ophthalmologists are usually less familiar and comfortable with gonioscopy, they are the ones who treat and follow most patients with OHT and glaucoma.…”

Review of glaucoma management in France

“…This type of research has already been conducted regarding glaucoma to determine the target IOP according to French ophthalmologists. 5 Internationally, a 2016 Indian study 6 ) utilizing an online questionnaire reveals glaucoma specialists' preference for applanation tonometry, four-mirror gonioscopy, and Humphrey perimetry. A 2008 English study 7 assessed the accessibility of examinations for glaucoma management in hospital wards, surveying 493 ophthalmologists and finding that the accessibility of automated perimetry was 99.6%, whereas OCT was 45.2%, and pachymetry was 79.7%.…”