• R R A Bourne, K A French, L Chang, A D Borman, M Hingorani, and W D Newsom.
• Glaucoma Service, Department of Ophthalmology, Hinchingbrooke Hospital, Huntingdon, Cambridgeshire, UK. rb@rupertbourne.co.uk
• Eye (Lond). 2010 May 1; 24 (5): 881-7.

Background/AimsTo describe the design, activity, and quality of the referral refinement phase of a novel glaucoma shared-care scheme.MethodsEight 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.ResultsOne 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.ConclusionThis referral refinement process can reduce numbers of false-positive referrals attending the hospital glaucoma service while retaining a relatively high level of examination quality.

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