Monitoring glaucoma in the community 

Community based optometrists play a critical role in the detection of eye disease. Optometrists are usually the first to assess people for glaucoma and refer those at risk to a specialist centre or hospital. 

With support from an innovation grant, Moorfields optometrist Dr Anish Jindal is leading a project to evaluate clinical decisions and assessment of those at risk of glaucoma by community optometrists. 

Over the last few decades, the expanding aging population has resulted in increased demand for services that diagnose and treat chronic disease. Glaucoma is one such disease that, if untreated, can lead to blindness. 

There is an increase in the number of glaucoma patients and need for long term treatment with monitoring. 

This has resulted in a significant demand in the hospital eye service (HES). COVID-19 has heightened this effect, with many hospitals facing a backlog of glaucoma outpatient appointments.

It is essential that patients who are at highest risk of blindness are examined and monitored appropriately.

Around half the patients referred for a suspect narrow angle for further investigation are healthy. This can result in wasted time and costs for both the hospital and patients.

The exact reasons for this phenomenon are currently unknown but could be due to limited referral guidance or the misinterpretation of a narrow angle by the referee. 

It remains important to improve the accuracy of detection, as even non-referred narrow angle patients will need annual reviews in the community.

Dr Anish Jindal and colleagues will investigate clinical decisions by community optometrists who account for most of the primary angle closure referrals into the HES.

Dr Jindal will also examine whether an innovative educational package could improve angle closure referrals. These could help identify what type of learning could assist in glaucoma detection and evaluation.

To deliver the project, the team will have acquired a clinical image database at Moorfields and use these to test with the optometrists that will also incorporate a learning package on angle closure referrals.

Community-based optometrists will complete a questionnaire about their clinical decision making.

The aim of this work is to support the future delivery of innovative educational packages that could ultimately improve clinical decisions.

This could reduce the number of referrals and enable sustained community monitoring of those at low risk of developing primary angle closure glaucoma in their lifetime.