A new referral and collaborative care plan developed by Australian researchers may help patients with angle closure by improving clinical care timelines and reducing the number of incidental diagnoses.

Currently, no specific collaborative care pathway exists that distinguishes open-angle glaucoma from narrow angle or angle-closure disease, researchers noted.

Investigators reviewed the medical records of patients referred to the Centre for Eye Health for glaucoma assessment six months before (group one) and after (group two) the introduction of the anterior chamber angle assessment referral plan (group three).

The study reported the 77 patients in group three got an appointment much sooner compared with those in group two (383 patients) and those in group three (425 patients).

Following the introduction of the referral plan, researchers also reported a reduction of incidental angle closure disease found in routine, non-angle closure glaucoma assessments. Additional referral was required by 36.4% of patients referred for suspected angle-closure disease, while the rest of the patients were either discharged (13%) or reviewed at the Centre for Eye Health (50.6%). Researchers also found including an angle description in the referral letter improved the true positive rate for angle-closure disease.

“The clinical pathway may reduce the number of incidental angle-closure patients and improve the timeliness of appropriate clinical care delivered to a subset of patients who may benefit from prompt medical attention,” the researchers wrote in their paper. “This pathway provides an opportunity for appropriately staffed and equipped collaborative care clinics to reduce the burden on tertiary level ophthalmic facilities.”

Phu J, Hennessy MP, Spargo M, et al. A collaborative care pathway for patients with suspected angle closure glaucoma spectrum disease. Clin Exp Optom. May 23, 2019. [Epub ahead of print].