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Kira Szulborski, Amer Alwreikat, Shiyoung Roh, David J Ramsey; Analysis of Glaucoma Referral Patterns at a Tertiary Medical Center. Invest. Ophthalmol. Vis. Sci. 2020;61(7):3067.
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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.
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.
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).
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.
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