Abstract
Purpose :
The aim of this study is to understand the factors that limit the comprehensive evaluation of patients with primary open angle glaucoma (POAG) referred to a sub-specialist.
Methods :
Retrospective, cross-sectional study of 72 internal referrals for POAG from ophthalmology versus optometric providers to the glaucoma service at the Lahey Hospital & Medical Center, a multispecialty academic group practice. The quality of the referral was assessed according to: (1) the completeness of the clinical triad of recorded intraocular pressure (IOP) measurement, visual field (VF), and cup-to-disc ratio (CDR) for each eye, and (2) the availability of all data necessary to calculate the Ocular Hypertension Treatment Study (OHTS) score.
Results :
The rate of completeness using both the clinical triad and OHTS score as measures of quality was similar for ophthalmic and optometric referrals. There was a significant increase in the availability of the clinical triad (57% to 65%; p=0.01) and the OHTS score (24% to 35%; p=0.004) from the time of referral to the consult, largely driven by the addition of VF studies. The amount of time between the referral and the initial sub-specialist consult differed between referrals from ophthalmologists and optometrists (46.5±32.3 days versus 67.1±44.2 days, p<0.001).
Conclusions :
Many patients referred to a sub-specialist provider in glaucoma lacked key clinical data necessary to confirm the diagnosis and/or evaluate the stage, severity, or progression of the disease. There remains considerable room for improvement in the management of patients referred for evaluation of glaucoma. A majority of clinical data collection should be performed by referring providers ahead of sub-specialty consultation, thereby improving both the efficiency and effectiveness of sub-specialist consultation.
This is a 2020 ARVO Annual Meeting abstract.