Choong Y F, Devarajan N, Pickering A, Pickering S, Austin M W
Department of Ophthalmology Singleton Hospital Sketty Swansea, UK.
Eye (Lond). 2003 Aug;17(6):685-90. doi: 10.1038/sj.eye.6700633.
The purpose of this study was to identify any consensus of opinion among consultant ophthalmologists in Wales with respect to the initial management of glaucoma referrals based on the published guidelines of the Royal College of Ophthalmologists (RCO) and to compare consultant opinion with the practice in a typical hospital.
The RCO guidelines document was studied to identify clear statements, which could be adopted as standards for audit purposes. A questionnaire was designed and sent to all consultant ophthalmologists in Wales (n=37) to obtain their opinions. An audit was performed of 100 consecutive patients referred to our unit as glaucoma suspects with regard to initial management. Descriptive statistical analysis was performed.
A good response rate for a postal questionnaire was obtained (81%) with 79.1% of responders finding the guidelines of at least some help. Levels of agreement with the definitions of ocular hypertension (OH) and primary open-angle glaucoma (POAG) were 76.7 and 86.7%, respectively. There was consensus of consultant opinion regarding many of the elements of the baseline clinical assessment with the significant exceptions of the necessity for dilated fundoscopy, gonioscopy, retinal nerve fibre layer assessment, and drawing of optic discs. The various 'clinical scenarios' for management of the RCO document were not all endorsed. The clinical audit results of the initial management of glaucoma referrals accurately reflected the consensus of the consultant opinion.
The RCO guidelines document represents a useful contribution to the management of patients with OH and POAG. Nevertheless, considerable variation in opinion exists concerning even the most basic areas. With the advent of clinical governance, bridging the gap between the conclusions of College working parties and realities of everyday practice will assume greater importance.
本研究旨在依据皇家眼科医学院（RCO）发布的指南，确定威尔士眼科顾问医师在青光眼转诊初始管理方面的意见共识，并将顾问医师的意见与一家典型医院的实际做法进行比较。
研究RCO指南文件，以确定可作为审核标准的明确陈述。设计了一份问卷并发送给威尔士所有的眼科顾问医师（n = 37）以获取他们的意见。对连续转诊至我们科室的100例疑似青光眼患者的初始管理情况进行审核。进行描述性统计分析。
邮寄问卷的回复率良好（81%），79.1%的回复者认为指南至少有一定帮助。对高眼压症（OH）和原发性开角型青光眼（POAG）定义的认同度分别为76.7%和86.7%。在基线临床评估的许多要素方面，顾问医师意见达成了共识，但散瞳眼底检查、房角镜检查、视网膜神经纤维层评估和视盘绘图的必要性存在显著例外。RCO文件中各种“临床情况”的管理建议并非都得到认可。青光眼转诊初始管理的临床审核结果准确反映了顾问医师意见的共识。
RCO指南文件对OH和POAG患者的管理有很大帮助。然而，即使在最基本的领域也存在相当大的意见差异。随着临床治理的出现，弥合学院工作小组的结论与日常实践现实之间的差距将变得更加重要。
