Optometrists already play an integral role in glaucoma diagnosis and management, but a new study from Australia suggests a more refined referral process can improve the diagnostic accuracy of OD-initiated referrals and decrease unnecessary additional visits to hospitals and other secondary clinics.

In aging populations, the prevalence of chronic diseases such as glaucoma is expected to increase, placing additional demands on limited healthcare resources, the researchers said in their paper. Collaborative care models that incorporate referral refinement—where glaucoma suspect referrals are triaged by trained optometrists through further testing—can potentially reduce false positive referrals, they added.

The study initially included 464 glaucoma suspects referred to the Glaucoma Management Clinic in Sydney, Australia, from 2015 to 2018. The referrals were generated by either a community optometrist (standard care) or after a comprehensive assessment at the Centre for Eye Health, which was defined as referral refinement.

Of the initial 464 referrals, 252 treatment-naïve glaucoma suspects were enrolled in the study. Following an assessment, 45.6% were prescribed treatment for open-angle glaucoma or ocular hypertension.

The positive predictive value of community optometry referrals was 33.8%, compared with 50.6% following referral refinement. The first visit discharge (false positive) rate was 26% for community referrals compared with just 4% from referral refinement. The researchers noted the predictive value increased with the number of abnormal clinical exam findings associated with referral. Additionally, the number of abnormal findings from referrals was much higher with referral refinement (1.9 vs. 1.5).

Huang J, Yapp M, Hennessy MP, et al. Impact of referral refinement on management of glaucoma suspects in Australia. Clin Exp Optom. December 18, 2019. [Epub ahead of print].