Dear Editor,

Stoutenbeek and Jansonius have demonstrated high rates of optometric consultations in the Netherlands as a basis for screening populations at risk of glaucoma .One of the aims of screening is understood to be the early detection of morbidity. We recently published a review[1] of all glaucoma patients registered blind at Manchester Royal Eye Hospital in 2003 and found that only 42% of these had their referrals initiated by by optometrists and that significant visual loss had occured prior to referral. We were able to correlate poor uptake of optometric services with socioeconomic deprivation.Laidlaw et al have already shown a reduction in glaucoma referrals to hospital eye services following the imposition of the sight test fee in the UK[2].

The high rates of optometric review may well be conducive to screening in the Netherlands. However access is certainly not universal and may still leave the most vulnerable at risk.

References

1.Henson DB & Thampy R. Preventing blindness from glaucoma.BMJ 2005;331:120-121

2.Laidlaw DAH, Bloom PA, Hughes AO, Sparrow JM, Marmion VJ. The sight test fee: effect on ophthalmology referrals and rate of glaucoma detection. BMJ 1994;309: 634-6.