Optometrists' Assessment of Pseudoexfoliation and Its Impact on Glaucoma Referrals

To determine the frequency and accuracy of pseudoexfoliation syndrome (PEX) assessment in referrals from primary care optometrists before the new Swedish glaucoma guidelines were established, and to evaluate an optometrist's ability to assess PEX.

We studied PEX assessments in 95 referrals (95 patients,189 eyes) with elevated intraocular pressure (IOP) from optometrists to the Skåne University Hospital in Malmö, Sweden, in 2019. We reviewed the frequency and accuracy of PEX assessments in referrals and compliance of these referrals with the new guidelines. In addition, an optometrist's ability to identify PEX was evaluated and compared to that of an ophthalmologist specialized in glaucoma. Patients referred were examined at the hospital for PEX, first by the study's optometrist and then by the ophthalmologist.

PEX was present in 17% of the patients (16 patients, 19 eyes). The optometrist in this study positively assessed PEX in 12 of 19 eyes (63%) before dilatation and in 14 of 19 eyes (74%) after dilatation. Seven referrals included a PEX assessment (3 assessed PEX and 4 assessed non-PEX), all of which were confirmed as correct. Of the 16 patients with PEX, 13 did not undergo a PEX assessment before referral. According to the new Swedish guidelines, three of the 13 referrals would not have been accepted, meaning that two patients requiring treatment would have been missed, one with pseudoexfoliation glaucoma and one with ocular hypertension with PEX.

Very few referrals from primary care optometrists included a PEX assessment (7%). According to the new guidelines, necessary referrals would therefore have been rejected. Still, the study's optometrist detected PEX in the majority of patients. The risk of missing high risk patients requiring glaucoma treatment would be reduced if primary care optometrists assess PEX before referral.