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Related Experiment Video

Updated: Jun 2, 2026

Assessing Early Stage Open-Angle Glaucoma in Patients by Isolated-Check Visual Evoked Potential

Assessing Early Stage Open-Angle Glaucoma in Patients by Isolated-Check Visual Evoked Potential

Published on: May 25, 2020

NICE - impact on glaucoma case detection.

Shima Shah¹, Ian E Murdoch

¹Moorfields Eye Hospital, London, UK.

Ophthalmic & Physiological Optics : the Journal of the British College of Ophthalmic Opticians (Optometrists)

|May 7, 2011

Summary

This summary is machine-generated.

Publication of NICE guidelines increased referrals for glaucoma suspects but did not improve case detection rates, questioning cost-effectiveness and suggesting a need for revised clinical governance.

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Area of Science:

Ophthalmology
Public Health Policy

Background:

The National Institute of Clinical Excellence (NICE) published guidelines in April 2009 for diagnosing and managing chronic open-angle glaucoma and ocular hypertension.
These guidelines aimed to standardize care and potentially impact referral patterns to community eye clinics.

Purpose of the Study:

To evaluate the effect of the 2009 NICE guidelines on referrals for suspect glaucoma to a specific community eye clinic.
To assess changes in the diagnostic yield and positive predictive value (PPV) of these referrals post-guideline implementation.

Main Methods:

A retrospective analysis of optometrist-initiated referrals for suspect glaucoma and ocular hypertension was conducted.
Referrals were assessed by a consultant ophthalmologist six months after guideline publication and categorized.
The positive predictive value (PPV) was calculated and compared to historical data.

Main Results:

A significant increase in the total number of new referrals was observed.
However, there was no corresponding increase in the absolute number of confirmed glaucoma or glaucoma suspect cases identified.
The number of ocular hypertensive patients increased, but the PPV decreased to 0.25, lower than in previous studies.

Conclusions:

The increased referral volume following NICE guidelines did not lead to improved detection of glaucoma or glaucoma suspects.
The lower PPV raises concerns about the cost-effectiveness and efficiency of the current referral system under the new guidelines.
Further investigation into repeat review strategies with robust clinical governance is recommended to optimize case detection and resource allocation.