Can a community optometrist-based referral refinement scheme reduce false-positive glaucoma hospital referrals without compromising quality of care? The community and hospital allied network glaucoma evaluation scheme (CHANGES)

Eye (Lond). 2010 May;24(5):881-7. doi: 10.1038/eye.2009.190. Epub 2009 Jul 31.


Background/aims: To describe the design, activity, and quality of the referral refinement phase of a novel glaucoma shared-care scheme.

Methods: Eight Optometrists with a Specialist Interest in glaucoma (OSI) were trained to perform a community-based comprehensive glaucoma evaluation of low-risk glaucoma hospital referrals (only one/none of the following factors noted for either eye: abnormal optic disc, abnormal visual field, abnormal intraocular pressure (IOP; 22-28 mmHg or IOP asymmetry)) using equipment standardized to that of the hospital glaucoma service.

Results: One hundred and thirty-eight (27%) of a total of 512 glaucoma-related referrals were deemed 'low risk'. Their choice of OSI discharged 40 (35%). The consultant agreed (virtually) with the decision to discharge with 28 (70%) and disagreed with 12 (30%). Comparing findings between OSI and consultant for 99 referred patients, sensitivity, specificity, and negative predictive values for a suspicious optic disc were 78, 61, and 79%, respectively. For an IOP of >21 mmHg, they were 74, 85, and 90%, respectively. For an occludable anterior chamber angle (Van Herick's versus gonioscopy), they were 69, 88, and 94%, respectively.

Conclusion: This referral refinement process can reduce numbers of false-positive referrals attending the hospital glaucoma service while retaining a relatively high level of examination quality.

MeSH terms

  • Community Health Services / organization & administration
  • Community Health Services / standards*
  • Community Networks / organization & administration*
  • Glaucoma / diagnosis*
  • Glaucoma / physiopathology
  • Hospitals, Community / organization & administration
  • Humans
  • Intraocular Pressure
  • Optometry / organization & administration
  • Optometry / standards*
  • Quality of Health Care / standards
  • Referral and Consultation / organization & administration
  • Referral and Consultation / standards*
  • Sensitivity and Specificity
  • United Kingdom
  • Vision Screening / organization & administration
  • Vision Screening / standards
  • Visual Fields