Glaucoma management in Sweden - results from a nationwide survey (original) (raw)
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Proposing new indicators for glaucoma healthcare service
Eye and vision (London, England), 2017
Glaucoma is the first leading cause of irreversible blindness worldwide with increasing importance in public health. Indicators of glaucoma care quality as well as efficiency would benefit public health assessments, but are lacking. We propose three such indicators. First, the glaucoma coverage rate (GCR), which is the number of people known to have glaucoma divided by the total number of people with glaucoma as estimated from population-based studies multiplied by 100%. Second, the glaucoma detection rate (GDR), which is number of newly diagnosed glaucoma patients in one year divided by the population in a defined area in millions. Third, the glaucoma follow-up adherence rate (GFAR), calculated as the number of patients with glaucoma who visit eye care provider(s) at least once a year over the total number of patients with glaucoma in given eye care provider(s) in a specific period. Regularly tracking and reporting these three indicators may help to improve the healthcare system pe...
Ophthalmic and Physiological Optics, 2014
Purpose: Guidelines for the screening, prognosis, diagnosis, management and prevention of glaucoma were released by the Australian National Health and Medical Research Council in 2010. Comparable guidance has been made available by respective bodies in the USA and UK at a similar time. Key to successful translation of guidelines into clinical practice includes clinicians having the necessary skills to perform required tests. Optometrists in Australia and New Zealand were invited to participate in an online survey exploring these aspects. The results provide insights for improving glaucoma diagnosis and management by optometric primary eye care practitioners. Methods: An online questionnaire was developed to investigate glaucoma assessment of optometrists as a function of demographic details, educational background and experience. Key points to ascertain compliance with current guidelines were the availability of equipment, procedural confidence in techniques, and preferences in visual field tests. Chi square statistics was employed to support similarity to national averages and highlight differences between the two countries. Multivariate linear regression analysis identified variables significantly associated with individual tests being available to optometrists and their confidence in applying them. Results: Thirteen per cent of all Australian and 36% of the New Zealand optometrists responded to the survey in 2013, which reflected the demographics/geography of the practising populations. Techniques considered essential or preferred for glaucoma assessment were widely available in both countries with the exception of gonioscopy and pachymetry. After correcting for availability, regression models highlighted therapeutic endorsement and knowledge of glaucoma guidelines as the main variables to maintain high diagnostic confidence. Correlations to number of years in optometric practice mirrored a changed emphasis in teaching and technology over the past 10-15 years. Conclusions: Australian and New Zealand optometrists were well equipped to perform glaucoma assessments with the possible exception of gonioscopy. Advanced imaging modalities were not yet fully integrated into optometric practice, although optical coherence tomography has shown use by 23-32% of optometrists. A marked increase in use, availability and procedural confidence of gonioscopy and other techniques with therapeutically endorsed optometrists demonstrates the advantage and importance of additional training.
The United Kingdom Glaucoma Treatment Study
Ophthalmology, 2013
Objective: The United Kingdom Glaucoma Treatment Study (UKGTS) tests the hypothesis that treatment with a topical prostaglandin analog, compared with placebo, reduces the frequency of visual field (VF) deterioration events in patients with open-angle glaucoma (OAG) by 50% over a 2-year period. Additional goals are to evaluate study power with novel clinical trial outcomes: (1) VF deterioration velocity and (2) VF and quantitative imaging measurements modeled as joint outcomes.
The Bristol shared care glaucoma study: outcome at follow up at 2 years
British Journal of Ophthalmology, 2000
Aim-To examine the outcome of care for patients with glaucoma followed up by the hospital eye service compared with those followed up by community optometrists. Methods-A randomised study with patients allocated to follow up by the hospital eye service or community optometrists was carried out in the former county of Avon in south west England. 403 patients with established or suspected primary open angle glaucoma attending Bristol Eye Hospital and meeting defined inclusion and exclusion criteria were studied. The mean number of missed points on visual field testing in the better eye (using a "better/worse" eye analysis) in each group were measured. The visual field was measured using the Henson semiautomated central field analyser (CFA 3000). Measurements were made by the research team on all patients at baseline before randomisation and again 2 years after randomisation. The mean number of missed points on visual field testing in the worse eye, mean intraocular pressure (mm Hg), and cup disc ratio using a "better/worse" eye analysis in each group at 2 years were also measured. Measurements were made by the research team on all patients at baseline before randomisation and again 2 years after randomisation. An analysis of covariance comparing method of follow up taking into account baseline measurements of outcome variables was carried out. Additional control was considered for age, sex, diagnostic group (glaucoma suspect/established primary open angle glaucoma), and treatment (any/none).
Summary of eight years ‘Glaucoma Day’ screening
Public Health, 2015
Glaucoma is the second leading cause of blindness and a leading cause for irreversible visual loss. 1 The type of disease in the elderly population is mainly primary open-angle glaucoma (POAG); primary closed-angle glaucoma (PCAG) is more associated with genetic factors. Recognized risk factors for POAG include: ocular hypertension (OHT), 2 increasing age 3 ; myopia, 4 certain ethnicities, 5 family history of glaucoma, 6 diabetes, 7 and arterial hypertension. 8 Due to the progressive natural course of glaucoma, early detection, appropriate medical or surgical treatment, and monitoring are particularly important, to decrease the risk of vision loss and blindness and the associated social burden, and to increase quality of life. 9 However, a population-based cohort study of individuals aged 55 years and above demonstrated that most of those with incident POAG were unaware of having this condition. 3 Due to the importance of early detection of glaucoma, the Ophthalmology Department of Ziv Medical Center launched an annual one-day screening program. They assessed cup-to-disk ratio and ocular tension, which are the main factors that are examined in glaucoma screening. The authors also checked for known co-morbidities and family history of glaucoma.