Quality improvement: where is gonioscopy?

Abstract

Purpose : Prevalence of Primary Closure Angle Glaucoma should be 32,04 millions in 2040¹. The first choice for angle assessment is gonioscopy². Our analysis, made at the Centre Universitaire d’Ophtalmologie (CUO), revealed that the gonioscopy post YAG laser iridotomy treatment is documented in only 27,7% of the patients who undergo the treatment. The aim of this study was to improve this practice in order to identify patients who, despite the laser treatment, have narrow iridocorneal angle and therefore remain at risk of developing glaucoma.

Methods : An interventional plan was implemented at the CUO for 17 weeks. All ophthalmologists and the staff were updated on the gonioscopy pre and post iridotomy guidelines in order for them to apply these recommendations during the patients’ follow-ups. The ophthalmologists (n=19) performing a YAG Laser iridotomy at the CUO have compiled data about the gonioscopy pre and post iridotomy. This analysis was done again one year after the study.

Results : During the intervention plan, a total of 74 patients have had an iridotomy and 52 of those patients (70.3%) have had a gonioscopy post iridotomy. The mean time between the intervention and the follow up was 5 weeks. After one year, 63% of the treated eyes have had a gonioscopy post iridotomy, with a follow up of 11 weeks.

Conclusions : Our results showed an increased rate of gonioscopy post iridotomy going from the documented 27.7% to 70.3%. This new rate approximates the American Academy of Ophthalmology recommendation³, which requires that any iridotomy must be followed with a gonioscopy in order to have a view of the iridocorneal angle. An interventional plan can be an important and effective tool to improve patients’ safety and the quality of care given. Quality improvement should be reported according to standards⁴.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.