Quality of referrals for glaucoma assessment: a cross-sectional survey of clinical data and outcomes

Int Ophthalmol. 2021 Dec;41(12):4065-4073. doi: 10.1007/s10792-021-01979-8. Epub 2021 Jul 30.

Abstract

Purpose: This study assessed the completeness of clinical information provided by ophthalmological and optometric referrals to glaucoma specialists consulting for open-angle glaucoma (OAG).

Methods: A retrospective, cross-sectional study of 72 internal referrals for evaluation of OAG in a multispecialty group practice was performed. The quality of the referral was assessed based on: (1) the completeness of the clinical triad of intraocular pressure measurement, visual field (VF), and cup-to-disk ratio for each eye; (2) the availability of the data necessary to calculate an ocular hypertension treatment study (OHTS) score; and (3) the presence of retinal nerve fiber layer (RNFL) imaging by mean of optical coherence tomography.

Results: The clinical triad was available in 57% of referrals, whereas an OHTS score was calculable in 24% of referrals (p < 0.001); RNLF imaging was available in 51% of referrals (p = 0.859). The completeness of clinical information was similar for ophthalmological and optometric referrals. From the date of referral to the time of the consultation, there was a significant increase in the availability of the clinical triad (57-65%; p = 0.013) and the OHTS score (24-5%; p = 0.004) but not for RNFL imaging (51-56%; p = 0.618). The most common missing clinical information was VF testing, which was absent in 42% of referrals.

Conclusions: Key clinical data necessary for effective diagnosis and staging of OAG was lacking for many patients referred to glaucoma specialists.

Keywords: Ophthalmologist; Optometrist; Outcome; Primary open-angle glaucoma.

MeSH terms

  • Cross-Sectional Studies
  • Glaucoma* / diagnosis
  • Glaucoma, Open-Angle* / diagnosis
  • Humans
  • Intraocular Pressure
  • Nerve Fibers
  • Referral and Consultation
  • Retinal Ganglion Cells
  • Retrospective Studies
  • Tomography, Optical Coherence