Glaucoma assessment tools used by clinicians: old or gold?

Abstract

PurposeGlaucoma is the main cause of irreversible blindness worldwide. Early detection and personalized management is the key to prevent or slow disease progression. Our group previously evaluated the quality of within‐hospital referral to a glaucoma subspecialty department (GSD), raising awareness to the importance of doing applanation tonometry (AT), gonioscopy and visual fields (VF) before referral. The aim of this work was to perform an audit cycle, one year after the awareness training session in December 2015.MethodsRetrospective analysis of a random sample of within‐hospital referrals to the GSD, in Lisbon Academic Medical Center (January 2016 to May 2017). Electronic records were screened for clinical data, exams, medical and surgical treatments prior to referral. Descriptive statistics were performed with SPSS.ResultsA total of 150 patients (69 males) were included in this analysis, with a mean age of 65 years [range 10–93]. Mean intraocular pressure (IOP) was 19.8 mmHg. Almost 20% of patients were not on any IOP‐lowering drugs, while nearly half were under ≥2 classes of treatment. AT and VF were performed respectively in 43% and 59% of the referred patients, both versus 49% in 2015 (p > 0.05). Gonioscopy was described for 23% of patients, more than the 12% mentioned in 2015 (p = 0.014). Optical coherence tomography (OCT) was performed in the large majority, 85%, as in the first analysis. Only 6% of patients had all AT, gonioscopy and VF; and 19% were referred with none of these exams, comparing to the 22% in the original 2015 screening (p > 0.05).ConclusionsOverall, training session did not significantly improve the quality of GSD referral, though more physicians reported gonioscopy results. It seems many clinicians still prefer more expensive and sophisticated exams as OCT, often forgetting valuable and simpler tools.