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Preeti Thyparampil, Benjamin Frankfort, Silvia Orengo-Nania; Correlation between decision to refer for glaucoma and diagnosis of glaucoma. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3497. doi: https://doi.org/.
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To study whether patients referred from the optometry service to the ophthalmology service, at the Veterans Affairs Hospital in Houston, Texas, for suspected glaucoma have a high incidence of treatment-requiring glaucoma.
A retrospective chart review was performed on 127 patients who presented as new patients to the optometry service of the Eye Care Line at the Veterans Affairs Medical Center in Houston, Texas. Patients were selected from a larger cohort according to predetermined criteria for consideration for referral to the ophthalmology service for glaucoma evaluation, which included IOP ≥ 22 in either eye, cup-to-disc ratio ≥ 0.6 in either eye, or cup-to-disc asymmetry ≥ 0.2. Data examined included whether or not patients were referred to the ophthalmology service, factors which correlated with greater likelihood of referral, and final treatment decision.
32 patients were referred to the ophthalmology service. Of these, 18 (56%) were treated for glaucoma. Of the 95 patients who were not referred, 21 (22%) were treated for glaucoma. This difference is statistically significant with chi-square testing (p value < 0.001). Ancillary testing was also more likely to be performed in patients referred for glaucoma. Of patients referred for glaucoma evaluation, 24/32 (75%) received Humphrey visual field testing and 25/32 (78%) received OCT RNFL or HRT tests. Of patients not referred for glaucoma evaluation, 39/95 (41%) received Humphrey visual field testing and 59/95 (62%) received OCT RNFL or HRT tests. On average, referred patients were found to be older in age, have higher maximum cup to disc ratio, higher inter-eye difference in cup to disc ratio, higher IOP and higher inter-eye difference in IOP. Of these age, maximum cup to disc ratio in either eye and higher inter-eye difference in IOP were statistically significant. When comparing patients who were referred to those who were not referred but treated, highest cup to disc ratio in either eye was the only statistically significant factor.
Patients who were referred to the ophthalmology service from the optometry service had a higher probability of treatment for glaucoma. Referred patients were also more likely to receive ancillary testing as part of management. The decision to refer was based primarily on differences in cup:disc ratio. IOP elevations did not correlate significantly with likelihood of referral.
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