Decision making in chronic glaucoma – optometrists vs ophthalmologists in a shared care service

Abstract

Shared care schemes have become popular in glaucoma management in the UK over the past 20 years. Published audits of decision making processes by non-ophthalmologists working in such schemes are however rare. Our aim was to audit the appropriateness of optometrists' decision-making when working in an in-house shared care glaucoma scheme. A single masked comparison study utilising retrospective consensus decisions by two ophthalmologists compared with 'live' optometrist decisions from three optometrists who reviewed patients with glaucoma, suspect glaucoma and ocular hypertension. Comparisons were made on management decisions on 140 consecutive eligible patients. There were high degrees of agreement (>88%) in terms of visual field interpretation, medical and surgical management decisions, timing of next appointment and ordering of visual field tests. Accuracy of communication with primary physicians was excellent with two optometrists but sub-optimal in a third. An audit model of decision-making in shared care is demonstrated that in this case supported the apprenticeship model of training utilised in the clinic.