Diagnosisand Management of Chronic Open Angle Glaucoma (COAG) in a Palestinian Eye Hospital Diagnosisand Management of Chronic Open Angle Glaucoma (COAG) in a Palestinian Eye Hospital (original) (raw)
Related papers
Evaluation of primary open-angle glaucoma clinical practice guidelines
Objective: To evaluate the methodologic quality of 3 primary open-angle glaucoma (POAG) clinical practice guidelines (CPGs). Design: The CPGs were assessed with the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Participants: Four authors (A.M.W., C.M.W., B.K.Y., D.J.W.) performed independent assessments of POAG CPGs.
Ophthalmic and Physiological Optics, 2015
Previous studies confirmed that optometrists have access to and confidence in applying clinical tests recommended for glaucoma assessment. Less is known about factors best predicting compliance with national clinical guidelines and thus by inference, the provision of suitable care by primary care ophthalmic practitioners. We utilised the unique two-tiered profession (therapeutic and non-therapeutic scope of practice) in Australia and New Zealand to assess the prospective adherence to glaucoma guidelines dependent on the clinician's background. Methods: Australian and New Zealand optometrists were surveyed on ophthalmic techniques for glaucoma assessment, criteria for the evaluation of the optic nerve head, glaucoma risk categories and review times while also recording background, training, and experience. Parameters identifying progression/conversion and patients' risk levels were analysed comparatively to ophthalmologists' opinions. Linear regression analysis identified variables significantly improving the likelihood of concordance with guidelines. Results: Reported application of techniques complied well with glaucoma guidelines although gonioscopy and pachymetry, pupil dilation for optic nerve head examination, and acquisition of permanent records were less frequently employed. The main predictors for entry-level diagnostic standards were therapeutic endorsement together with the associated knowledge of relevant guidance and procedural confidence. Other findings suggested a potential underestimation in the value of optic disc size and intraocular pressure for the prediction of glaucoma risk, while optometrists more frequently relied on the outcomes of nonstandardised automated perimetry and auxiliary imaging. Conclusions: Optometrists in Australia and New Zealand may not always exercise optimal clinical acumen regarding techniques/criteria for glaucoma diagnosis. Therapeutic endorsement was gradually adopted in different jurisdictions in various forms since 1999 and is mandatory for registration since late 2014. The result of the twotiered optometric cohorts suggest that inclusion of therapeutic training as part of the core training is likely a key factor to enhanced compliance with glaucoma guidelines. Improved adherence to the current clinical standards should positively impact on the facilitation of appropriate glaucoma diagnosis and management. Obligatory knowledge and possibly accreditation of available guidelines might ensure a uniform standard in glaucoma testing protocols in concordance with compulsory entry-level skills.
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...
Eye, 2012
Aims Optometrists are becoming increasingly involved in the co-management of glaucoma patients as the burden on the Hospital Eye Service continues to escalate. The aim of this study was to assess the agreement between specially trained optometrists and glaucoma-specialist consultant ophthalmologists in their management of glaucoma patients. Methods Four optometrists examined 23-25 patients each and the clinical findings, up to the point of dilation, were documented in the hospital records. The optometrist, and one of two consultant ophthalmologists, then independently examined and documented the optic-disc appearance before recording their decisions regarding the stability and management of the patient on a specially designed proforma. Percentage agreement was calculated together with kappa or weighted kappa statistics, where appropriate. Results Agreement between consultants and optometrists in evaluating glaucoma stability was 68.5% (kappa (k) ¼ 0.42-0.50) for visual fields, 64.5% (weighted k ¼ 0.17-0.31) for optic discs, and 84.5% (weighted k ¼ 0.55-0.60) for intraocular pressures. Agreement regarding medical management was 96.5% (k ¼ 0.73-0.81) and for other glaucoma management decisions, including timing of follow-up, referral to a consultant ophthalmologist, and discharge, was 72% (weighted k ¼ 0.65). This agreement increased to 90% following a retrospective independent then consensus review between the two consultants and when qualified agreements were included. Of the 47 glaucoma and nonglaucoma queries generated during the study, 42 resulted in a change of management. Conclusion Confirming the ability of optometrists to make appropriate decisions regarding the stability and management of glaucoma patients is essential if their involvement is to continue to develop to meet the demand of an aging population.
Patient Preference and Adherence, 2008
Primary open angle glaucoma is a chronic optic neuropathy often requiring lifelong treatment. Patient compliance, adherence and persistence with therapy play a vital role in improved outcomes by reducing morbidity and the economic consequences that are associated with disease progression. A literature review including searches of The Cochrane Library, MEDLINE, PubMed, conference proceedings, and bibliographies of identifi ed articles reveals the enormous public health burden in various populations due to the impact of glaucoma associated visual impairment on the overall quality of life eg, fear of blindness, inability to work in certain occupations, driving restrictions, motor vehicle accidents, falls, and general health status. Providing specifi c defi nitions for the frequently misunderstood terms "compliance, persistence and adherence" with reference to medication use is central not only for monitoring patients' drug dosing histories and clinical outcomes but also for subsequent research. In this review article, a summary of the advantages/disadvantages including cost-effectiveness of various medical approaches to glaucoma treatment, techniques employed for measuring patient compliance and actual patient preferences for therapy are outlined. We conclude by identifying the key barriers to ongoing treatment and suggest some best practices to enhance compliance and persistence.
Clinical Challenges and Priorities in Managing Glaucoma Patients
ESASO Course Series, 2016
There are challenges in managing glaucoma patients and priorities need to be determined. Early in the course of the disease, managing subjects with ocular hypertension (OHT) is a challenge. The risk calculator is a useful guide to decide on early preventive treatment in those with OHT and to recommend treatment in patients at high risk for progression to glaucoma. Moreover, although wellaccepted clinical criteria defining glaucomatous optic disk damage contribute to diagnostic accuracy, clinical diagnosis remains subjective relying on qualitative assessment of the optic disk. As a result, even among glaucoma experts, agreement in optic disk assessment is not excellent. In addition, visual field (VF) damage due to glaucoma has recently been associated with quality of life (QoL) measures, although a specific threshold of VF damage beyond which QoL is affected has not been determined yet. On the other hand, risk factors for glaucoma have been identified in major clinical trials, as well as the potential role of setting an individual target in lowering intraocular pressure (IOP). Despite this knowledge, we are not able to predict the rate of VF progression of the individual patient at baseline. In addition, glaucoma progresses at widely different rates among individual patients even within the same glaucoma type. Therefore,
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).