Optometrists and the management of glaucoma; the Rotterdam experience

Abstract

SummaryShared glaucoma care is performed in 2 different ways in the Rotterdam area: 1) through telemedicine connecting optometrists and a glaucoma specialist and 2) by technicians following a strict working protocol in a separate department of the Rotterdam Eye Hospital. In the Telemedicine project, extensive information is provided via a secured internet connection, including a detailed history, pachymetry, applanation tonometry, slit lamp examination, gonioscopy, fundus photographs and sophisticated imaging (OCT or GDx). It primarily serves the detection of glaucoma and the monitoring of those at risk. In the hospital based follow‐up, strict criteria are observed that require referral to the glaucoma clinic; these criteria relate to the history, visual acuity, applanation tonometry, target IOP and any progression in structural or functional measurements. Eligible patients are those deemed stable. Both projects function well. In the Telemedicine project, initially 32% of patients were referred to a glaucoma specialist, but, as the provided information improved, later only approx. 10%. The hospital based follow‐up unit was preferred slightly by the patients to the regular visits to their glaucoma specialists.