The agreement between optometrists and consultant ophthalmologists on the glaucoma management of patients attending a first-contact virtual glaucoma clinic

The authors present the results from a service evaluation audit conducted at the Belfast Health and Social Care Trust glaucoma clinic.

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Abstract

This study aimed to assess the agreement between the management decisions made by specialist trained glaucoma optometrists and a consultant ophthalmologist (with a specialist interest in glaucoma) within a hospital-based virtual glaucoma clinic. Visual acuity, applanation tonometry, visual field and stereoscopic optic nerve head photographs were performed (by nursing and technical staff) on 58 consecutive newly referred patients attending the glaucoma virtual clinic. Two optometrists analysed the clinical information available and recorded management decisions on a paper pro forma. The consultant ophthalmologist conducted the virtual assessment on the same 58 patients and recorded the findings on the patient’s electronic Medisoft record. Agreement regarding overall management decision, diagnosis of glaucoma (including treated ocular hypertension and treated glaucoma suspects) and agreement regarding initiation of treatment were all considered. Optometrists had a good level of agreement with each other across all categories (overall management decision wkappa 0.670 se 0.17; agreement regarding diagnosis of glaucoma wkappa 0.617 se 0.129; agreement regarding initiation of treatment wkappa
0.618 se 0.129). When compared to the consultant ophthalmologist, both optometrists had a moderate level of agreement regarding overall management decisions (optometrist 1: wkappa 0.569 se 0.255; optometrist 2: wkappa 0.418 se 0.184). Fair levels of agreement were found between optometrists and consultant ophthalmologists regarding diagnosis of glaucoma (optometrist 1: wkappa 0.227 se 0.157; optometrist 2: wkappa 0.226 se 0.189) and initiation of treatment (optometrist 1: wkappa 0.226 se 0.157). Optometrist 2 had slightly poorer levels of agreement regarding initiation of treatment (wkappa 0.197 se 0.140). Optometrists appear to have a satisfactory level of clinical decision-making ability in the context of a glaucoma clinic. Agreement correlation levels in the current study are fairly similar to other studies investigating interclinician correlation. ThÍe current study differs significantly from other studies in that assessments were performed in a virtual clinic setting and all participants were new referrals into the service.

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