Article Text

Download PDFPDF
Glaucoma detection: the content of optometric eye examinations for a presbyopic patient of African racial descent
  1. R Shah1,2,
  2. D F Edgar2,
  3. P G Spry3,
  4. R A Harper4,
  5. A Kotecha2,
  6. S Rughani1,
  7. B J W Evans1,2
  1. 1
    The Neville Chappell Research Clinic, The Institute of Optometry, 56–62 Newington Causeway, London, UK
  2. 2
    Henry Wellcome Laboratories for Vision Sciences, Department of Optometry and Visual Science, City University, Northampton Square, London, UK
  3. 3
    Bristol Eye Hospital, Lower Maudlin Street, Bristol, UK
  4. 4
    Academic Department of Ophthalmology, Manchester Royal Eye Hospital, Oxford Road, Manchester, UK
  1. Dr R Shah, The Neville Chappell Research Clinic, The Institute of Optometry, 56–62 Newington Causeway, London SE1 6DS, UK; rakhee19{at}


Aims: Standardised patient (SP) methodology is the gold standard for evaluating clinical practice. We investigated the content of optometric eyecare for an early presbyopic SP of African racial descent, an “at-risk” patient group for primary open-angle glaucoma (POAG).

Methods: A trained actor presented unannounced as a 44-year-old patient of African racial descent, complaining of recent near vision difficulties, to 100 community optometrists for an audio-recorded eye examination. The eye examinations were subsequently assessed via a checklist based on evidence-based POAG reviews, clinical guidelines and expert panel opinion.

Results: Ninety-five per cent of optometrists carried out optic disc assessment and tonometry, which conforms to the UK College of Optometrists’ advice that those patients aged >40 years should receive at least two of the following tests: tonometry, optic disc assessment, visual field testing. Thirty-five per cent of optometrists carried out all of these tests and 6% advised the SP of increased POAG risk in those of African racial descent.

Conclusion: SP encounters are an effective measure of optometric clinical practice. As in other healthcare disciplines, there are substantial differences between optometrists in the depth of their clinical investigations, challenging the concept of a “standard sight test”. There is a need for continuing professional development (CPD) in glaucoma screening, in which the increased risk of POAG in those of African racial descent should be emphasised.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding: The present work was funded in part by EyeNET, the Association of Optometrists, the Royal National Institute of Blind People (RNIB), the Central (LOC) Fund, the American Academy of Optometry (British Chapter) and the College of Optometrists.

  • Competing interests: None declared. The views expressed in this publication are those of the authors and not necessarily those of any of the funding organisations. The funding sources had no role in the design, conduct, or reporting of the study or in the decision to submit the manuscript for publication. The researchers had open and full access to all the data files for the study and had full control over the data.

  • Ethics approval: Obtained.

  • Patient consent: Obtained.

  • RS, DFE and BJWE are members of EyeNET, the primary care eye research network supported by the Department of Health.