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Gordon Bowler, Habiba Saedon, Rachel Thomas, Wai Chan; Laser Surgery in the United Kingdom. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5970.
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Peripheral iridotomy (PI) creates a non pupillary aqueous drainage route to eliminate the relative pupillary block component of angle closure. Nd:YAG laser iridotomy has been long established as a satisfactory alternative to operative iridectomy in acute angle closure treatment & prophylaxis. The aim of this cross-sectional study was to elucidate the current practice of ophthalmologists practicing in the United Kingdom and to suggest recommendations for good practice.
This study was an anonymous national cross-sectional survey, distributed online in December 2010, by the electronic tool surveymonkey.com.
480 UK based practitioners were invited to participate in the email survey. 48 practitioners responded, representing a wide range of experience: Consultants and Fellows (53.2%), trainees & middle grade doctors (46.8%). Most practitioners (71.7%) had performed between 1 & 20 PI’s in the last year and 91.5% of practitioners would perform a PI in an eye with angle closure in the affected and fellow eye. Gonioscopy and IOP measurement are always performed by 61.7% and 72.3% of respondents respectively. 54.3% practitioners use a contact lens and the argon pretreatment rate in brown irides was 22.2%. IOP is always measured after the procedure by 55.9% of practitioners. 12% of respondents do not give any medication post-operatively, and the majority of practitioners (96.7%) follow up patients post PI.
This study highlights a wide variation in PI practice among UK ophthalmologists. In the UK, 51% of respondents would perform PIs in patients who were asymptomatic with occludable angles. This is in contrast to a much higher percentage, 84.9%, in a survey carried out in Singapore. Singapore has one of the highest incidences of acute primary angle closure in the world, which may be the reason for a much higher percentage. A limitation of the study was the relatively low response rate, but a variety of grades of doctors from a wide geographical location was achieved. We suggest that standardised clinical guidelines are developed and made available through the Royal College of Ophthalmologists portal to improve patient care and provide a benchmark for outcomes.
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