Outcomes of glaucoma referrals across Europe

Abstract

 

Purpose

 

To assess differences in the outcomes of glaucoma referrals across European countries.

 

Methods

 

Two hundred and fifty patients newly referred to a Glaucoma Specialist Practice were prospectively and consecutively enrolled by five centres (50 patients/centre) in the United Kingdom (UK), Hungary, Slovenia, Italy and Greece. The referral source and reason for referral were recorded. To reflect real-life clinical practice, subjects were examined according to the protocol followed in each centre and diagnosis was left to the discretion of the glaucoma expert. A management outcome was defined as positive when intervention or further monitoring was offered. Differences in quantitative variables across centres were assessed with ANOVA. The association between qualitative variables was assessed with chi-square test or Fisher's exact test whenever the expected count was <5. All p-values were two-tailed with a significance level of 5%.

 

Results

 

Sex (overall 44.0% males, 56% females) and age (overall mean±standard deviation 57.6±16.3 years) of referred subjects did not differ between centres (ANOVA p=0.056 and chi-square test p=0.052, respectively). In the UK 20% of patients were African and 12% were Asian, whereas in other countries almost all patients were Caucasian (Fisher’s exact test P<0.001). Glaucoma diagnosis was less frequent in the UK (10%), Hungary (10%) and Greece (14%), whereas it was more frequent in Slovenia (48%) and Italy (42%) (Fisher’s exact test p<0.001) (table 1). Similarly, Italy (78%) and Slovenia (72%) had higher percentages of positive outcomes, whereas these were lower for Greece (40%), Hungary (46%) and the UK (54%) (Chi-square test P<0.001). Most referrals were initiated by optometrists in the UK (56%), and by ophthalmologists in Hungary (64%), Slovenia (94%), Italy (54%) and Greece (64%) (Fisher’s exact test P<0.001). Interestingly, a third of all referred subjects in Hungary, Italy and Greece were self-referrals. In all centres, intraocular pressure >21mmHg was the commonest reason for referral (overall 47.6%) (Fisher’s exact test P<0.001). A smaller percentage of subjects were referred because of suspicious optic discs (23.2%) or suspicious visual fields (14%) (table 2).

 

Conclusions

 

Despite a structured system for glaucoma referrals in the UK, glaucoma diagnosis and positive outcomes were less frequent compared to other European countries. In all centres, less than 50% of referred subjects were diagnosed with glaucoma.