NICE guidelines for glaucoma diagnosis and management have resulted in more patients referred but no increase in the absolute numbers of glaucoma and glaucoma suspects identified.
A study looked at optometrist initiated referrals for suspect glaucoma and ocular hypertension to the Moorfields Community Eye Clinic at Ealing Hospital over a two-month period some six months after the publication of the NICE guidelines. Each referral was then classified as either glaucoma negative, ocular hypertensive requiring further follow-up in the hospital, ocular hypertensive to be followed up by the community optometrist, or 'other'.
The positive predictive value (PPV) was then calculated and compared with historical values from previous studies. Overall there were 110 new referrals, which suggested a significant increase from previous tallies (eg 69 in 2002, 41 in 1999).
Although there was a significant increase in the number of ocular hypertensives referred, the number of patients identified as glaucoma positive or suspect did not rise. Furthermore, the PPV calculated for the period fell to 0.25, lower than any previous studies. The findings led the researchers to question any advantage in improved case detection since the NICE guidelines' publication and also the cost effectiveness of a scheme which results in higher referral rates but no significant increase in positive diagnosis for glaucoma. A repeat review is suggested.
The study is published in the July issue of Ophthalmic and Physiological Optics which has Dr Robert Harper, co-author of the Essential Glaucoma Handbook, as guest editor. To order copies of the handbook, please telephone 020 8652 8243.