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Brett Malbin, Aman Shukairy, Bret A Hughes, Justin Tannir, Anju Goyal, Chaesik Kim; Gonioscopy Practice Patterns. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2598.
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© ARVO (1962-2015); The Authors (2016-present)
The purpose of this study is to evaluate a clinical practice pattern for gonioscopy exams on new patients for both comprehensive ophthalmologists and glaucoma fellowship trained ophthalmologists. Then we examine changes in the practice pattern between 2008 and 2012 to see how a changing landscape of preferred practice patterns has influenced clinical practice.
IRB approval was obtained to conduct a retrospective study of 800 charts of patients who received a billing code consistent with a first time visit to a Kresge Eye Institute ophthalmologist. The charts were evaluated to discern if patients received a gonioscopy exam on their initial visit. This variable was compared between four different groups: comprehensive ophthalmologist in 2008 (200 charts), comprehensive ophthalmologist in 2012 (200), glaucoma fellowship trained ophthalmologist in 2008 (200), and glaucoma fellowship trained ophthalmologist in 2012 (200).
199 out of the total 800 patients (24.9%) received gonioscopy on their initial visit. In 2008, 87 (21.8%) patients received gonioscopy compared to 112 (28%) patients in 2012 (p<0.05). When comparing glaucoma faculty to comprehensive ophthalmologist for the year 2008, comprehensive ophthalmologist performed 1 (0.5%) gonioscopy exam compared to glaucoma faculty who conducted 86 (43%) (p<0.05). In 2012 comprehensive ophthalmologists performed 4 (2%) initial gonioscopy exams while glaucoma faculty conducted 108 (54%) (p<0.05). Examining the change from 2008 to 2012 for comprehensive ophthalmologist showed an increased rate from 0.5% to 2% for initial gonioscopy exams (p=.18). Data over the same period for glaucoma faculty showed an increased rate of 43% to 54% (p<0.05).
A wide variation exists between comprehensive ophthalmologist and glaucoma specialists in regards to performing a gonioscopy exam on a new patient’s first visit. These differences are likely due to glaucoma specialist treating more patients with glaucoma who require angle closure to be ruled out. When comparing years 2008 and 2012, the significant increase in the number of gonioscopy exams conducted by glaucoma faculty can in part be attributed to increased education and awareness surrounding proper gonioscopy exam and billing at the Kresge Eye Institute. Though we have demonstrated improvement through educational initiatives, further educational advances are need to continue improving gonioscopy exam rates.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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