The Peterborough scheme for community specialist optometrists in glaucoma: results of 4 years of a two-tiered community-based assessment and follow-up service

Curr Eye Res. 2015 Jul;40(7):690-6. doi: 10.3109/02713683.2014.957326. Epub 2014 Oct 13.


Aims: To report on results of an innovative glaucoma shared-care scheme based in Peterborough, UK.

Methods: A retrospective review of all new appointments with 11 community-based specialist optometrists in glaucoma (SOG) was conducted. There are two tiers of SOG, whereby tier 2 SOGs have increased levels of autonomy. All optometrist assessments were reviewed by a consultant ophthalmologist, and levels of agreement were calculated for assessment of optic nerve head appearance, Humphrey visual field test interpretation, diagnosis and outcome.

Results: 1639 new patients were assessed by SOGs over a 4-year period. The median waiting time for patients from referral to SOG assessment was 0 days (IQR 0-56), and from SOG assessment to consultant review in a virtual clinic was 12 days (IQR 8-18days). After first appointment, over 60% of patients were classified as low-risk and remained within the SOG scheme. Rates of frank disagreement between SOG and consultant regarding diagnosis and proposed outcome were 5.6 and 10.4%, respectively, for tier 2 SOGs and 15.3 and 28.6%, respectively, for tier 1 SOGs.

Conclusions: The SOG scheme demonstrates acceptable levels of accuracy between SOG and glaucoma consultant. This scheme allows many stable low-risk patients to remain out of hospital eye department outpatient clinics.

Keywords: Community; glaucoma; optometrist; shared care.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anterior Chamber / pathology
  • Community Health Services / organization & administration
  • Community Health Services / standards*
  • Corneal Pachymetry
  • Decision Making
  • Female
  • Follow-Up Studies
  • Glaucoma / diagnosis*
  • Gonioscopy
  • Humans
  • Intraocular Pressure / physiology
  • Male
  • Middle Aged
  • Ocular Hypertension / diagnosis
  • Ophthalmology*
  • Optometry*
  • Patient Care Team / organization & administration
  • Patient Care Team / standards*
  • Referral and Consultation
  • Retrospective Studies
  • Specialization*
  • Tonometry, Ocular
  • United Kingdom
  • Visual Field Tests
  • Visual Fields / physiology
  • Waiting Lists