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Glaucoma case finding: a cluster-randomised intervention trial.

J Theodossiades1, I Murdoch, S Cousens

  • 1Department of Epidemiology and International Eye Health, Institute of Ophthalmology, and Moorfields Eye Hospital, London, UK. i.murdoch@ucl.ac.uk

Eye (London, England)
|May 8, 2004
PubMed
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An intervention to improve glaucoma referral training significantly increased the number of referrals from optometrists, but the positive predictive value remained unchanged. Further research is needed to confirm the impact on glaucoma detection.

Area of Science:

  • Ophthalmology
  • Public Health

Background:

  • Glaucoma is a leading cause of irreversible blindness worldwide.
  • Early detection and timely referral are crucial for managing glaucoma and preventing vision loss.
  • Optometrist referrals are a key component of the glaucoma diagnostic pathway.

Purpose of the Study:

  • To evaluate an intervention designed to enhance optometrist referrals for suspected glaucoma.
  • To assess the intervention's effect on referral numbers and the positive predictive value (PPV) of those referrals.

Main Methods:

  • Cluster randomized controlled trial involving optometric practices referring to a hospital eye clinic.
  • Intervention included training in optic disc assessment, explicit referral criteria, and ophthalmologist feedback.
  • Data collected on new patient referrals, attendance rates, and PPV over a 20-month period.

Related Experiment Videos

Main Results:

  • Referrals from intervention practices nearly doubled compared to control practices (210 vs. 119).
  • Estimated intervention effect of a 52% increase in referrals, though wide confidence intervals (95% CI: -35% to 253%) limit conclusiveness due to high design effect.
  • Positive predictive value of referrals was similar between intervention (0.49) and control (0.46) groups.

Conclusions:

  • The intervention led to a substantial increase in glaucoma referrals from optometrists.
  • The unchanged PPV suggests the intervention did not alter the accuracy of referrals.
  • A larger trial is necessary to provide conclusive evidence of the intervention's impact on referral numbers and glaucoma detection.