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David Cordeiro Sousa, Ines Cardoso Leal, Carlos Marques-Neves, Manuel Monteiro-Grillo, Luis Abegao Pinto; Assessment of the quality of within-hospital glaucoma referral in a tertiary hospital in Portugal. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2591.
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© ARVO (1962-2015); The Authors (2016-present)
Glaucoma is a progressive and irreversible optic neuropathy carrying tremendous burden in healthcare systems. An effective referral scheme and a timely observation in consultation are essential for providing efficient and personalized care to our patients. The aim of our study was to evaluate the within-hospital referral to a glaucoma subspecialty department (GSD).
We analyzed retrospectively the within-hospital referral to the GSD in Lisbon Academic Medical Center. Electronic medical records and referral letters between Jan-Dec 2014 were screened. Data was screened for clinical examination, performed ancillary exams, type of tonometry and IOP-lowering drugs. Data analysis included descriptive statistics using STATA v13.0.
151 patients (78 males) were referred. Mean age was 68.2 years [range 18-91]. The number of patients below 36 and over 79 years-old were 5 (3,3%) and 29 (19.2%), respectively. Mean logMar best-corrected visual acuity was 0.42 ± 0.85 and mean intraocular pressure (IOP) at the time of referral was 18.4 ± 4.7 mmHg [range 9.5-33]. IOP was measured using Goldmann applanation tonometry in only 65 (48,5%) patients. A gonioscopy was described in 18 (11.9%) patients. A corneal pachymetry was obtained in 46 (30.5%) patients. Regarding antiglaucomatous drugs, 83 (55.0%) patients were on 2 or more anti-glaucomatous topical drugs. Among these, 15 (18,1%) were under maximal therapy (including patients on oral acetazolamide). At least one visual field examination was performed in 74 (49.0%) patients and visual field mean defect 8.72 ± 7.19 dB, with 24 (15.8%) of the patients having more than two visual field tests. Structural examinations [retinal nerve fiber layer (RNFL) thickness with optical coherent tomography] was performed in 128 patients (84.8%), being the mean RNFL thickness 79.0 ± 17.5 μm [range 34-135].
A significant proportion of first-time referred patients within a tertiary glaucoma department lack clinically relevant information, with data on visual field and Goldmann applanation tonometry existing in less than half of referred patients. Optimizing referral system is crucial in increasing efficiency of decision-making in a GSD.
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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