Glaucoma management in primary care: barriers perceived by optometrists in Scotland.

Abstract

Over the next 10years, the prevalence of glaucoma in the United Kingdom (UK) is predicted to rise by 22%,(The Way Forward: Glaucoma, The Royal College of Ophthalmologists, London, 2017) posing a considerable challenge to already overstretched hospital eye services. To help address this problem, services traditionally offered in hospital such as managing stable glaucoma patients, could be transferred to community optometrists. The aim of this study was to identify whether optometrists in Scotland have an interest in managing primary open angle glaucoma (POAG) in primary care and to assess perceived barriers. All optometrists on the NHS Education Scotland (NES) database were invited to participate in an online survey over a 7-week period. Optometrists were asked if they had an interest in being accredited to manage POAG in the community and a free text question was used to elicit perceived barriers. Responders with an interest in managing POAG were invited to take part in two further rounds of electronic surveying, using a modified Delphi approach, with the aim of reaching a consensus on perceived barriers. Two hundred and ninety-nine of 1566 optometrists (19%) responded to the survey. 229 (79%) expressed an interest in managing patients with POAG in primary care. The most commonly perceived barriers after two rounds of Delphi surveying were remuneration (29%), communication with secondary care (18%), perceived ophthalmology resistance (13%), training (11%) and capacity (10%). Multivariate regression revealed fewer years in practice and comfort using and interpreting results of pachymetry were associated with higher odds of interest in managing glaucoma in the community. Among survey responders, there was significant interest from community optometrists to being accredited to manage POAG in primary care. A collaborative approach between primary and secondary care will be required to address the concerns of community optometrists in any future expansion of their role in glaucoma management.