EXTENDED REPORT

The accuracy of accredited glaucoma optometrists in the diagnosis and treatment recommendation for glaucoma

A Azuara-Blanco¹, J Burr², R Thomas², G Maclennan² and S McPherson^1,3

¹ The Eye Clinic, Aberdeen Royal Infirmary, Aberdeen, UK
² Health Services Research Unit, University of Aberdeen, Aberdeen, UK
³ McPherson Optician, King Street, Aberdeen, UK

Correspondence to:
Augusto Azuara-Blanco, The Eye Clinic, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK; aazblanco{at}aol.com

Aim: To compare the diagnostic performance of accredited glaucoma optometrists (AGO) for both the diagnosis of glaucoma and the decision to treat with that of routine hospital eye care, against a reference standard of expert opinion (a consultant ophthalmologist with a special interest in glaucoma).

Methods: A directly comparative, masked, performance study was undertaken in Grampian, Scotland. Of 165 people invited to participate, 100 (61%) were examined. People suspected of having glaucoma underwent, within one month, a full ophthalmic assessment in both a newly established community optometry led glaucoma management scheme and a consultant led hospital eye service.

Results: Agreement between the AGO and the consultant ophthalmologist in diagnosing glaucoma was substantial (89%; = 0.703, SE = 0.083). Agreement over the need for treatment was also substantial (88%; = 0.716, SE = 0.076). The agreement between the trainee ophthalmologists and the consultant ophthalmologist in the diagnosis of glaucoma and treatment recommendation was moderate (83%, = 0.541, SE = 0.098, SE = 0.98; and 81%, = 0.553, SE = 0.90, respectively). The diagnostic accuracy of the optometrists in detecting glaucoma in this population was high for specificity (0.93 (95% confidence interval, 0.85 to 0.97)) but lower for sensitivity (0.76 (0.57 to 0.89)). Performance was similar when accuracy was assessed for treatment recommendation (sensitivity 0.73 (0.57 to 0.85); specificity 0.96 (0.88 to 0.99)). The differences in sensitivity and specificity between AGO and junior ophthalmologist were not statistically significant.

Conclusions: Community optometrists trained in glaucoma provided satisfactory decisions regarding diagnosis and initiation of treatment for glaucoma. With such additional training in glaucoma, optometrists are at least as accurate as junior ophthalmologists but some cases of glaucoma are missed.

Abbreviations: AGO, accredited glaucoma optometrist; HES, hospital eye service; IOP, intraocular pressure; OAG, open angle glaucoma

Keywords: glaucoma; optometry; ophthalmology; diagnosis

Competing interests: None declared.

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