The Peterborough Scheme for Community Specialist Optometrists in Glaucoma: Results of 4 Years of a Two-Tiered Community-Based Assessment and Follow-up Service

Roberts, Harry; Rughani, Keshma; Syam, Padmanhaba; Dhingra, Sumit; Ramirez-Florez, S

doi:10.3109/02713683.2014.957326

Cited by 30 publications

(34 citation statements)

References 26 publications

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“…The present study identified a potential clinical pathway for patients with suspected angle closure spectrum disease, where the majority of patients do not require onward ophthalmological assessment. The overall proportion of all patients who could be discharged back into the community for ongoing optometric care (20.1 per cent) was similar to some previous reports and was lower than others . Specifically with regard to patients referred for angle assessment, gonioscopic findings were not once noted in the referral letter, indicating a gap in current community optometry that is addressed in the present model.…”

Section: Discussionsupporting

confidence: 79%

“…The overall proportion of all patients who could be discharged back into the community for ongoing optometric care (20.1 per cent) was similar to some previous reports 6,11,24 and was lower than others. 7,[25][26][27] Specifically with regard to patients referred for angle assessment, gonioscopic findings were not once noted in the referral letter, indicating a gap in current community optometry that is addressed in the present model. Notably, although gonioscopy is a current graduate level clinical competency in optometry in Australia 28 and is one of the clinical tests expected to be performed in the comprehensive assessment of glaucoma, its use is not widespread in community practice.…”

Section: Discussionmentioning

confidence: 81%

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A collaborative care pathway for patients with suspected angle closure glaucoma spectrum disease

Phu

Hennessy

Spargo

et al. 2020

Clinical and Experimental Optometry

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Background Currently, no specific collaborative care pathway exists that distinguishes open angle glaucoma from narrow angle or angle closure disease. This study evaluates a newly developed referral and collaborative care pathway specifically for patients with angle closure spectrum disease. Methods The medical records of consecutive patients referred to the Centre for Eye Health for glaucoma assessment were examined, six months before (Pre Suite) and after (Post Suite) the introduction of a novel referral pathway for anterior chamber angle assessment (Angle Suite). Patient demographic and clinical data, the referral letter and practitioner characteristics were extracted. Results Angle Suite (n = 77) patients had an appointment much sooner compared to Pre (n = 383) and Post Suite (n = 425) patients (p < 0.0001). Following the introduction of Angle Suites, there was a reduction of incidental angle closure disease found in routine, non‐angle closure glaucoma assessment. Onward referral was required by 36.4 per cent of patients referred for suspected angle closure disease, while the rest could be discharged back into the community (13.0 per cent) or reviewed at the Centre for Eye Health (50.6 per cent). Multinomial logistic regression found that the presence of an angle description in the referral letter improved the true positive rate for angle closure disease (p < 0.0001). Conclusions The clinical pathway may reduce the number of incidental angle closure patients and improved the timeliness of appropriate clinical care delivered to a subset of patients who may benefit from prompt medical attention. This pathway provides an opportunity for appropriately staffed and equipped collaborative care clinics to reduce the burden on tertiary level ophthalmic facilities.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 81%

A collaborative care pathway for patients with suspected angle closure glaucoma spectrum disease

Phu

Hennessy

Spargo

et al. 2020

Clinical and Experimental Optometry

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“…EOS for community monitoring of patients with stable glaucoma or OHT have been evaluated . These services are protocol‐driven and generally overseen by the HES.…”

Section: Resultsmentioning

confidence: 99%

“…A RCT, comparing community monitoring of patients with stable glaucoma to routine care in the hospital glaucoma clinic, found community optometrists could take clinical measurements of comparable quality to usual care and there was no difference in patient outcomes between the two arms of the trial over a 2‐year period . Other studies, observational in design, concluded that with further glaucoma training, community optometrists are an acceptable alternative to hospital care for selected glaucoma patients and those at increased risk of developing glaucoma. In summary, evidence from glaucoma services provides strong support for Theory 1.…”

Section: Resultsmentioning

confidence: 99%

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Effectiveness of UK optometric enhanced eye care services: a realist review of the literature

Baker

Ratnarajan

Harper

et al. 2016

Ophthalmic Physiologic Optic

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Purpose: UK demographic and legislative changes combined with increasing burdens on National Health Service manpower and budgets have led to extended roles for community optometrists providing locally-commissioned enhanced optometric services (EOS). This realist review's objectives were to develop programme theories that implicitly or explicitly explain quality outcomes for eye care provided by optometrists via EOS and to test these theories by investigating the effectiveness of services for cataract, glaucoma, and primary eye care. Methods: The review protocol was published on PROSPERO, and RAMESES publication standards were followed. Programme theories were formulated via scoping literature searches and expert consultation. The searching process involved all relevant electronic databases and grey literature, without restrictions on study design. Data synthesis focussed on questioning the integrity of each theory by considering supportive and refuting evidence from the source literature. Results: Good evidence exists for cataract, glaucoma and primary eye care EOS that: with appropriate training, accredited optometrists manage patients commensurate with usual care standards; genuine partnerships can exist between community and hospital providers for cataract and glaucoma EOS; patient satisfaction with all three types of service is high; cost-effectiveness of services is unproven for cataract and primary eye care, while glaucoma EOS cost-effectiveness depends on service type; contextual factors may influence service success. Conclusions: The EOS reviewed are clinically effective and provide patient satisfaction but limited data is available on cost-effectiveness.

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The Future Is Now: Incorporating Telemedicine into Glaucoma Care

Ertel

Kahook

Young

2021

Curr Ophthalmol Rep

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Purpose of Review The field of teleglaucoma has expanded rapidly in recent years with several large-scale teleglaucoma screening programs in existence throughout the world. Additionally, teleglaucoma programs for use in disease management are under study. The limited access to care that resulted from the COVID-19 pandemic highlighted the need for expansion of such programs. This article reviews the literature on teleglaucoma for screening and management of glaucoma, discussing considerations for incorporating teleglaucoma into clinical practice. Recent Findings Teleglaucoma screening reduces the rate of false-positive referrals and can accurately screen at-risk populations with accuracy similar to in-person screening. The use of teleglaucoma for the management of glaucoma shows promise for low-risk patients with early disease. Furthermore, teleglaucoma is cost-effective and reduces travel burden for patients resulting in high patient satisfaction. Summary Teleglaucoma offers potential for improving access to glaucoma care, reducing the burden on patients and health care systems.

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The Peterborough Scheme for Community Specialist Optometrists in Glaucoma: Results of 4 Years of a Two-Tiered Community-Based Assessment and Follow-up Service

Abstract: The SOG scheme demonstrates acceptable levels of accuracy between SOG and glaucoma consultant. This scheme allows many stable low-risk patients to remain out of hospital eye department outpatient clinics.

Cited by 30 publications

References 26 publications

A collaborative care pathway for patients with suspected angle closure glaucoma spectrum disease

A collaborative care pathway for patients with suspected angle closure glaucoma spectrum disease

Effectiveness of UK optometric enhanced eye care services: a realist review of the literature

The Future Is Now: Incorporating Telemedicine into Glaucoma Care

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