Agreement between specially trained and accredited optometrists and glaucoma specialist consultant ophthalmologists in their management of glaucoma patients

• Published in: Eye (London) Vol. 26; no. 6; pp. 853 - 861
• Main Authors: Marks, J R, Harding, A K, Harper, R A, Williams, E, Haque, S, Spencer, A F, Fenerty, C
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.06.2012; Nature Publishing Group
• Subjects: 692/1537; 692/699; 692/700/228; Adult; Aged; Aged, 80 and over; Antihypertensive Agents - administration & dosage; Biological and medical sciences; Clinical Audit; Clinical Competence - standards; Clinical Study; Credentialing; Filtering Surgery; Glaucoma; Glaucoma - diagnosis; Glaucoma - therapy; Glaucoma and intraocular pressure; Health Services Research; Humans; Intraocular Pressure - physiology; Laboratory Medicine; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Miscellaneous; National Health Programs; Ophthalmology; Ophthalmology - standards; Optic Disk - pathology; Optic Nerve Diseases - diagnosis; Optic Nerve Diseases - therapy; Optometry - standards; Patient-Centered Care; Pharmaceutical Sciences/Technology; Referral and Consultation; Retrospective Studies; Surgery; Surgical Oncology; Visual Fields - physiology; agreement; shared care; specialist optometrist; glaucoma; glaucoma-specialist consultant ophthalmologist; Glaucoma; Human; Protozoa; Care; Agreement; Eye disease; Clinical management; Glaucoma (eye); Ciliata; Ophthalmology
• ISSN: 0950-222X; 1476-5454
• DOI: 10.1038/eye.2012.58

Aims Optometrists are becoming increasingly involved in the co-management of glaucoma patients as the burden on the Hospital Eye Service continues to escalate. The aim of this study was to assess the agreement between specially trained optometrists and glaucoma-specialist consultant ophthalmologists in their management of glaucoma patients. Methods Four optometrists examined 23–25 patients each and the clinical findings, up to the point of dilation, were documented in the hospital records. The optometrist, and one of two consultant ophthalmologists, then independently examined and documented the optic-disc appearance before recording their decisions regarding the stability and management of the patient on a specially designed proforma. Percentage agreement was calculated together with kappa or weighted kappa statistics, where appropriate. Results Agreement between consultants and optometrists in evaluating glaucoma stability was 68.5% (kappa ( κ )=0.42–0.50) for visual fields, 64.5% (weighted κ =0.17–0.31) for optic discs, and 84.5% (weighted κ =0.55–0.60) for intraocular pressures. Agreement regarding medical management was 96.5% ( κ =0.73–0.81) and for other glaucoma management decisions, including timing of follow-up, referral to a consultant ophthalmologist, and discharge, was 72% (weighted κ =0.65). This agreement increased to 90% following a retrospective independent then consensus review between the two consultants and when qualified agreements were included. Of the 47 glaucoma and non-glaucoma queries generated during the study, 42 resulted in a change of management. Conclusion Confirming the ability of optometrists to make appropriate decisions regarding the stability and management of glaucoma patients is essential if their involvement is to continue to develop to meet the demand of an aging population.