The Carmarthenshire Glaucoma Referral Refinement Scheme, a safe and efficient screening service

Area of Science:

• Ophthalmology
• Public Health

Background:

• Community refinement of glaucoma referrals is an established efficient method for managing glaucoma suspects.
• The potential for false negatives in such schemes has not been previously explored.

Purpose of the Study:

• To describe and assess a scheme designed to evaluate and control for false negatives in community glaucoma referral refinement.
• To report on the success of this scheme in terms of efficiency, safety, and cost-effectiveness.

Main Methods:

• Trained optometrists investigated patients with suspected glaucoma following an agreed protocol to reduce false positives.
• A review of 100 referred patient records and 100 community-retained patient records, including optic disc images, was conducted.

Main Results:

• The scheme achieved a 53% reduction in referrals to the Hospital Eye Service (HES), yielding a cost saving of £117 per patient.
• 83% of referred patients received a glaucoma diagnosis or were retained in HES for suspected glaucoma, showing good correlation with hospital measurements.
• Analysis of non-referred patients' records and optic nerve images indicated no compromise in patient safety.

Conclusions:

• Community-based refinement of suspected glaucoma referrals is effective, benefiting both patients and hospitals.
• The proposed scheme demonstrates safety and cost-effectiveness in managing glaucoma suspects, a novel finding in existing research.