Auditing service delivery in glaucoma clinics using visual field records: a feasibility study

Area of Science:

• Ophthalmology
• Health Services Research
• Data Science

Background:

• Glaucoma care relies on visual field (VF) testing.
• Electronic medical records (EMRs) contain vast amounts of patient data.
• Auditing service delivery is crucial for effective glaucoma management.

Purpose of the Study:

• To demonstrate the extraction of large-scale visual field data from EMRs.
• To assess the feasibility of calculating audit metrics from VF data.
• To evaluate the potential of these metrics for improving glaucoma care service delivery.

Main Methods:

• Extracted Humphrey visual field analyser (HFA) data from Medisoft EMRs across five English clinics.
• Defined target patients as those with measurable and sustained VF loss.
• Calculated metrics including VF reliability, stage of loss, speed of progression, and examination frequency.

Main Results:

• 34.8% of patients in EMRs had measurable VF loss (n=25,760).
• Median presenting mean deviation (MD) was -6 dB.
• Median MD loss was -0.2 dB/year with 11-month intervals between VF tests for patients with >4 years follow-up.
• Metrics varied significantly between clinics (p<0.001).

Conclusions:

• Analysis of VF data from EMRs is feasible for auditing glaucoma care.
• Proposed metrics can aid in blindness prevention strategies.
• This approach supports quality improvement in secondary care glaucoma services.