Cambridge community Optometry Glaucoma Scheme

Clin Exp Ophthalmol. 2015 Apr;43(3):221-7. doi: 10.1111/ceo.12398. Epub 2014 Sep 23.


Background: With a higher life expectancy, there is an increased demand for hospital glaucoma services in the United Kingdom.

Design: The Cambridge community Optometry Glaucoma Scheme (COGS) was initiated in 2010, where new referrals for suspected glaucoma are evaluated by community optometrists with a special interest in glaucoma, with virtual electronic review and validation by a consultant ophthalmologist with special interest in glaucoma.

Participants: 1733 patients were evaluated by this scheme between 2010 and 2013.

Methods: Clinical assessment is performed by the optometrist at a remote site. Goldmann applanation tonometry, pachymetry, monoscopic colour optic disc photographs and automated Humphrey visual field testing are performed. A clinical decision is made as to whether a patient has glaucoma or is a suspect, and referred on or discharged as a false positive referral. The clinical findings, optic disc photographs and visual field test results are transmitted electronically for virtual review by a consultant ophthalmologist.

Main outcome measures: The number of false positive referrals from initial referral into the scheme.

Results: Of the patients, 46.6% were discharged at assessment and a further 5.7% were discharged following virtual review. Of the patients initially discharged, 2.8% were recalled following virtual review. Following assessment at the hospital, a further 10.5% were discharged after a single visit.

Conclusions: The COGS community-based glaucoma screening programme is a safe and effective way of evaluating glaucoma referrals in the community and reducing false-positive referrals for glaucoma into the hospital system.

Keywords: community; diagnosis; glaucoma; optometry; teleophthalmology.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Community Medicine / organization & administration*
  • Diagnostic Techniques, Ophthalmological / standards*
  • False Positive Reactions
  • Glaucoma / diagnosis*
  • Glaucoma / therapy
  • Guideline Adherence
  • Humans
  • Intraocular Pressure
  • National Health Programs
  • Ocular Hypertension / diagnosis*
  • Ocular Hypertension / therapy
  • Ophthalmology / standards
  • Optic Disk / pathology
  • Optic Nerve Diseases / diagnosis
  • Optic Nerve Diseases / therapy
  • Optometry / standards*
  • Predictive Value of Tests
  • Referral and Consultation / standards*
  • Telemedicine / standards
  • Tonometry, Ocular
  • United Kingdom
  • Visual Fields