Abstract
Aim To describe a Manchester-based glaucoma referral refinement scheme designed to reduce the number of false-positive referrals to the hospital eye service. To report on the first years results of this scheme and its financial costs to the NHS.
Methods Patients with suspected glaucoma, instead of being referred to their GP and then on to the hospital eye service, were referred to a group of specially trained community optometrists working to an agreed set of referral criteria. Those patients who did not meet the referral criteria were returned to the referring optometrist, while those who met the referral criteria were referred directly to Manchester Royal Eye Hospital. The patient's GP was informed in all cases.
Results The number of suspect glaucoma cases referred to the Manchester Royal Eye Hospital was reduced by 40%. This figure is close to the percentage of false-positive referrals measured at Manchester Royal Eye Hospital prior to the onset of this study. The information accompanying referral has been improved and the scheme produces a small financial cost saving to the NHS of approximately £17 per patient.
Conclusion Community refinement of suspect glaucoma offers some important benefits over the current referral pathway.
Similar content being viewed by others
Login or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Harrison RJ, Wild JM, Hobley AJ . Referral patterns to an ophthalmic outpatient-clinic by general-practitioners and ophthalmic opticians and the role of these professionals in screening for ocular disease. BMJ 1988; 297: 1162–1167.
Clearkin L, Harcourt B . Referral pattern of true and suspected glaucoma to an adult ophthalmic outpatient clinic. Trans Ophthal Soc UK 1983; 103: 284–287.
Theodossiades J, Murdoch L . Positive predictive value of optometrist-initiated referrals for glaucoma. Ophthal Physiol Opt 1999; 19: 62–67.
Vernon SA . The changing pattern of glaucoma referrals by optometrists. Eye 1998; 12: 854–857.
Bell RWD, OBrien C . The diagnostic outcome of new glaucoma referrals. Ophthal Physiol Opt 1997; 17: 3–6.
Bell RWD, OBrien C . Accuracy of referral to a glaucoma clinic. Ophthal Physiol Opt 1997; 17: 7–11.
Tuck MW, Crick RP . Efficiency of referral for suspected glaucoma. BMJ 1991; 302: 998–1000.
Vernon SA, Ghosh G . Do locally agreed guidelines for optometrists concerning the referral of glaucoma suspects influence referral practice? Eye 2001; 15: 458–463.
Bruce Shields M, Tiedeman JS . Binocular ophthalmoscopic techniques for evaluations of the optic nerve head. In: Varma R, Spaeth GL, Parker KW (eds). The Optic Nerve in Glaucoma. JB Lippincott: Philadelphia, 1993, pp 127–136.
Tuck MW, Crick RP . Relative effectiveness of different modes of glaucoma screening in optometric practice. Ophthal Physiol Opt 1993; 13: 227–232.
Reidy A, Minassian DC, Vafidis G et al. Prevalence of serious eye disease and visual impairment in a north London population: population based cross sectional study. BMJ 1998; 316: 1643–1646.
Acknowledgements
This project has been supported by a grant from the Manchester Health Authority.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Henson, D., Spencer, A., Harper, R. et al. Community refinement of glaucoma referrals. Eye 17, 21–26 (2003). https://doi.org/10.1038/sj.eye.6700261
Received:
Revised:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.eye.6700261
Keywords
This article is cited by
-
A catalyst for change
Eye (2021)
-
Project Panopia: cost-effective model for glaucoma referral refinement from community optometrists without the need for repeat testing
Eye (2021)
-
Ophthalmic nurse practitioner assessment of glaucoma: evaluating agreement within an initiative to enhance capacity in glaucoma clinics
Eye (2021)
-
Development and implementation of a Greater Manchester COVID19 Urgent Eyecare Service
Eye (2021)
-
Care pathways for glaucoma detection and monitoring in the UK
Eye (2020)