Outcomes of newly referred patients with suspected angle closure: Do we need to redefine the clinical pathways?

Abstract

AbstractPurpose: To investigate outcomes of referrals for suspected angle closure and to explore whether anterior segment optical coherence tomography (AS‐OCT) can be used to tighten triaging criteria in a glaucoma virtual clinic.Methods: Retrospectively collected data. The first audit (04/2018–03/2019) identified referrals for suspected angle closure in the absence of other glaucoma‐related findings (primary angle closure suspect (PACS) referrals). All patients underwent gonioscopy. The second audit (04‐08/2019) identified consecutive patients with suspected angle closure in a virtual clinic. Management outcomes were assessed, using gonioscopy as the reference standard. Outcomes were re‐audited after changing the triaging criterion from angle width < 10° to iridotrabecular contact (ITC) in ≥1 quadrants on AS‐OCT.Results: Out of 1754 glaucoma referrals (first audit), 24.6% (431/1754) were PACS referrals. Of these, only 10.7% (42/393) had an occludable angle on gonioscopy, with 97.6% (41/42) being PACS. Of these, 78% (32/41) underwent laser peripheral iridotomy. Out of 137 referrals in the virtual clinic (second audit), 66.4% (91/137) were triaged to the face‐to‐face clinic. Of these, 31.9% (29/91) were discharged. AS‐OCT had positive and negative predictive value of 74.3% (95% confidence intervals (CI) 57.8–86.0) and 82.1% (95% CI 70.0%–90.2%), respectively, in detecting ITC in ≥1 quadrants. In the re‐audit 45.9% (45/98) of those with suspected angle closure were triaged for gonioscopy, with 24.4% (11/45) of them being discharged.Conclusions: PACS referrals represent a substantial burden to hospital‐based services and their ‘accuracy’ appears to be low. ITC in ≥1 quadrants on AS‐OCT can be useful in triaging those who need further evaluation with gonioscopy.