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Yvonne M. Buys, Rania Gaspo, Kenneth Kwok, Canadian Glaucoma Risk Factor Study Group; Referral Source, Symptoms and Disease Severity at Initial Diagnosis of Ocular Hypertension or Open-Angle Glaucoma. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5048.
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To evaluate the severity of glaucoma at presentation and relationship to referral source and reason for referral.
Prospective, Canadian multi-center, cross-sectional study. Consecutive consenting patients with newly diagnosed ocular hypertension (OH) or open-angle glaucoma (OAG) underwent a comprehensive ocular examination including medical history and presenting symptoms. Patient demographics and referral source were also obtained. Patients were classified as OH or mild, moderate or advanced glaucoma based on the Canadian Ophthalmological Society glaucoma guidelines. The proportion of subjects presenting in each disease category was determined. Disease severity at presentation was compared for differences in demographics, baseline ocular findings, referral source and symptoms.
404 subjects with newly diagnosed OH or OAG were enrolled. A total of 113 (28%) were diagnosed as OH and 291 (72%) as OAG. In the OAG group 151 (52%) had mild, 79 (27%) moderate and 61 (21%) advanced disease at initial diagnosis. The majority of the referrals were from optometrists (82%) followed by family physicians (7%) and ophthalmologists (7%). Referral patterns were significantly different for advanced disease as compared to the other severity levels (p=0.02). Optometrists were responsible for 83, 86, 80 and 70% of the referrals for OH, mild, moderate and advanced OAG respectively while ophthalmologists made 9, 5, 3 and 15% of these same referrals. The reason of referral for the advanced was significantly different than the other disease levels (p<0.0001). In more than half of the subjects the referral was made as a result of an abnormality noted by the referring source in an asymptomatic patient. The second most common reason for referral was the presence of risk factors. Visual symptoms noted by the subject was more common in the advanced (21%) disease as compared to OH (7%), mild (3%) and moderate (9%) disease.
Nearly half of the subjects with newly diagnosed OAG had moderate or advanced disease at the time of initial diagnosis. Although optometrists were responsible for the majority of the referrals this proportion was significantly less for those with advanced disease. These results raise the possibility of suboptimal detection services for glaucoma.
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