The changing pattern of glaucoma referrals by optometrists

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Abstract
Purpose To identify any change in optometric referral patterns for suspect glaucoma over a 5 year period. Method A restrospective analysis was carried out of referrals for suspect glaucoma to a hospital glaucoma clinic from 1988 and 1993. Results There was a significant decrease in the positive referral rate with time from 56% in 1988 to 37% in 1993 (p = 0.02). Intraocular pressures (IOPs) of all patients prior to referral and at presentation to the glaucoma clinic were significantly higher in 1988 (25.1 and 25.6 mmHg respectively) than in 1993 (22.4 and 23.0 mmHg respectively, p < 0.0005). However, the presenting IOPs of eyes with glaucoma were similar in the cohorts (27.5 vs 26.4 mmHg, p = 0.33). Prior to referral, optometrists performed visual fields on 28% of patients in 1988 and on 48% in 1993 (p 0.01), giving an estimate of the cup/disc ratio in 15% of patients in 1988 and 41% in 1993 (p = 0.0004). Conclusions The increased false positive referral rate appears to be associated with the increasing use of visual field analysers by optometrists and a willingness to refer at lower IOPs. Increased false positive referrals result in increased waiting times for hospital assessment.

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