A prospective study on effectiveness of elevated intraocular pressure as a criterion for glaucoma referrals by optometric practitioners in Sweden
(2021) In Acta Ophthalmologica 99(7).- Abstract
Purpose: To evaluate the outcome of referrals for suspected glaucoma based on elevated intraocular pressure (IOP) made by optometric practitioners in Sweden. Methods: This prospective study included 95 individuals referred to the Skåne University Hospital Malmö, Sweden, during 2019, by optometric practitioners, based on elevated IOP. Positive outcome was defined as a diagnosis of glaucoma, or a diagnosis of suspected glaucoma. Referral accuracy was analysed. Positive predictive values (PPV) of different hypothetical IOP and age thresholds were calculated. Results: In 34% (95% CI: 24–43%) of the referrals, no eye disease was found. Intraocular pressure (IOP) was the only referral criterion in 77% (73/95). The PPV was 35% (95% CI: 25–45%)... (More)
Purpose: To evaluate the outcome of referrals for suspected glaucoma based on elevated intraocular pressure (IOP) made by optometric practitioners in Sweden. Methods: This prospective study included 95 individuals referred to the Skåne University Hospital Malmö, Sweden, during 2019, by optometric practitioners, based on elevated IOP. Positive outcome was defined as a diagnosis of glaucoma, or a diagnosis of suspected glaucoma. Referral accuracy was analysed. Positive predictive values (PPV) of different hypothetical IOP and age thresholds were calculated. Results: In 34% (95% CI: 24–43%) of the referrals, no eye disease was found. Intraocular pressure (IOP) was the only referral criterion in 77% (73/95). The PPV was 35% (95% CI: 25–45%) for all referrals, 27% (95% CI: 16–38%) for IOP-only referrals and 59% (95% CI: 36–82%) for referrals including additional findings. In IOP-only referrals, no definite diagnosis of glaucoma was made in any patients <45 years of age. Applying a theoretical age limit of ≥45 years with a hypothetical IOP limit of ≥25 mmHg in patients 45–69 years and of ≥22 mmHg in patients ≥70 years increased the PPV to 42% (95% CI: 27–57%). IOP-only referrals would have been reduced by 27% without missing any glaucoma cases. Conclusion: The overall predictive value of the referrals was poor. Glaucoma resources would have been used more effectively by increasing the required age for IOP-only referrals to ≥45 years in combination with different IOP thresholds for certain age groups.
(Less)
- author
- Landgren, Karin and Peters, Dorothea LU
- organization
- publishing date
- 2021-01-10
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- effectiveness, IOP, open-angle glaucoma, optometric practitioners, referrals
- in
- Acta Ophthalmologica
- volume
- 99
- issue
- 7
- publisher
- Wiley-Blackwell
- external identifiers
-
- pmid:33423398
- scopus:85099057880
- ISSN
- 1755-375X
- DOI
- 10.1111/aos.14764
- language
- English
- LU publication?
- yes
- id
- ccc98b47-68c7-4a8c-9a57-3f0be022b233
- date added to LUP
- 2021-01-19 13:42:03
- date last changed
- 2024-06-13 05:42:17
@article{ccc98b47-68c7-4a8c-9a57-3f0be022b233,
abstract = {{<p>Purpose: To evaluate the outcome of referrals for suspected glaucoma based on elevated intraocular pressure (IOP) made by optometric practitioners in Sweden. Methods: This prospective study included 95 individuals referred to the Skåne University Hospital Malmö, Sweden, during 2019, by optometric practitioners, based on elevated IOP. Positive outcome was defined as a diagnosis of glaucoma, or a diagnosis of suspected glaucoma. Referral accuracy was analysed. Positive predictive values (PPV) of different hypothetical IOP and age thresholds were calculated. Results: In 34% (95% CI: 24–43%) of the referrals, no eye disease was found. Intraocular pressure (IOP) was the only referral criterion in 77% (73/95). The PPV was 35% (95% CI: 25–45%) for all referrals, 27% (95% CI: 16–38%) for IOP-only referrals and 59% (95% CI: 36–82%) for referrals including additional findings. In IOP-only referrals, no definite diagnosis of glaucoma was made in any patients <45 years of age. Applying a theoretical age limit of ≥45 years with a hypothetical IOP limit of ≥25 mmHg in patients 45–69 years and of ≥22 mmHg in patients ≥70 years increased the PPV to 42% (95% CI: 27–57%). IOP-only referrals would have been reduced by 27% without missing any glaucoma cases. Conclusion: The overall predictive value of the referrals was poor. Glaucoma resources would have been used more effectively by increasing the required age for IOP-only referrals to ≥45 years in combination with different IOP thresholds for certain age groups.</p>}},
author = {{Landgren, Karin and Peters, Dorothea}},
issn = {{1755-375X}},
keywords = {{effectiveness; IOP; open-angle glaucoma; optometric practitioners; referrals}},
language = {{eng}},
month = {{01}},
number = {{7}},
publisher = {{Wiley-Blackwell}},
series = {{Acta Ophthalmologica}},
title = {{A prospective study on effectiveness of elevated intraocular pressure as a criterion for glaucoma referrals by optometric practitioners in Sweden}},
url = {{http://dx.doi.org/10.1111/aos.14764}},
doi = {{10.1111/aos.14764}},
volume = {{99}},
year = {{2021}},
}