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The impact of SIGN glaucoma guidelines on false-positive referrals from community optometrists in Central Scotland
  1. Samantha Sii1,
  2. Ahmad Nasser2,
  3. Cheng Yi Loo3,
  4. Catherine Croghan4,
  5. Alan Rotchford4,
  6. Pankaj Kumar Agarwal5
  1. 1 Department of Ophthalmology, Belfast Health and Social Care Trust, Belfast, UK
  2. 2 NHS West Lothian Foundation Programme, St. Johns Hospital, Scotland, UK
  3. 3 Department of Ophthalmology, University of Edinburgh Medical School, Scotland, UK
  4. 4 Department of Ophthalmology, Tennent Institute of Ophthalmology, Glasgow, UK
  5. 5 Department of Ophthalmology, Princess Alexandra Eye Pavilion, Edinburgh, UK
  1. Correspondence to Dr Samantha Sii, Belfast Health and Social Care Trust, Belfast BT9 7BW, UK; samanthasii{at}


Background Since the introduction of National Institute for Health and Care Excellence glaucoma guidelines 2009, the number of referrals from community optometrists to hospital eye services has increased across the UK, resulting in increase in first visit discharge rates (FVDRs).

Aim To assess the impact of Scottish Intercollegiate Guidelines Network (SIGN) 144 on quality of referrals from community optometrists.

Methodology A retrospective study of patient records who attended as new adult glaucoma referrals to clinics in Princess Alexandra Eye Pavilion, Edinburgh, and in Greater Glasgow and Clyde, was carried out across October–November 2014 (group 1) and September–October 2016 (group 2), before and after the introduction of SIGN 144. The primary outcome of this study is FVDRs. A secondary outcome is the extent of compliance to referral recommendations by SIGN guidelines.

Results Three hundred and twelve and 325 patients were included in groups 1 and 2, respectively. There was a significant decline in FVDRs between these two periods from 29.2% to 19.2%. ( p=0.004) (OR 0.58 (95%CI 0.40 to 0.84)). Post-SIGN guidelines, 87% of referrals were compliant to SIGN referral criteria while 13% remained non-compliant. The main reasons for non-compliance were no repeatable visual field defects (42.0%) and referrals due to high intraocular pressure were either not repeated or not interpreted in the context of age and central corneal thickness (36.8%).

Conclusion Patients referred after the introduction of SIGN guidelines were 33.5% less likely to be discharged at the first visit. Although compliance to most recommendations in SIGN guidelines has improved, there is still a need to improve adherence to referral criteria

  • glaucoma

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  • Contributors SS and PKA initiated this project. SS, AN, CYL contributed to data collection in Edinburgh while AR and CC contributed to data collection in Glasgow. SS, AR and CC contributed to statistical analyses and descriptive synthesis of data. SS and AN contributed to the conceptualisation of this paper, while AR, CC and PKA critically revised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared

  • Patient consent Not required.

  • Ethics approval Obtained from National Health Service (NHS) local clinical governance committee based in South-East Lothian and Greater Glasgow and Clyde, Scotland.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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