Patel U D M, Murdoch I E, Theodossiades J
Optometry Department, Moorfields Eye Hospital, London, UK.
Eye (Lond). 2006 May;20(5):591-4. doi: 10.1038/sj.eye.6702000.
To establish whether the effect of improved glaucoma detection in the community suggested by an intervention study is maintained when intervention is extended to include all optometrists in the area.
Optometrists' in the Ealing, Hammersmith, and Hounslow area were invited to ongoing training sessions following completion of an intervention study. The number of optometrist initiated referrals to Ealing Hospital Eye Clinic (EHEC) for suspect glaucoma was assessed over a 12-month period. The positive predictive value (PPV) of those referrals was calculated and a historical comparison made with the results of the original study.
A total of 376 new referrals for suspected glaucoma were assessed at EHEC during the 12-month period of data collection. This represents an increase in the number of referrals of 58% compared with an equivalent 12-month period during the initial intervention trial (376 vs. 238). The PPV was maintained at 0.45 (95% CI 0.41-0.51).
The rising number of new referrals for glaucoma together with maintenance of the PPV suggests an impact on the number of new cases of glaucoma detected in the community. The increase in referral numbers was limited to glaucoma when compared with new referrals for cataract. This implies a targeted effect of the intervention in terms of glaucoma detection. We believe the next step is to perform the study in an alternative location to see if the effect is repeatable elsewhere. If proven to be the case, there is a coherent argument for widespread adoption of this strategy to improve glaucoma case finding.
确定当干预扩展至该地区所有验光师时，一项干预研究中所显示的社区青光眼检测改善效果是否能得以维持。
伊灵、哈默史密斯和豪恩斯洛地区的验光师在一项干预研究完成后被邀请参加持续培训课程。在12个月期间评估验光师转诊至伊灵医院眼科诊所（EHEC）怀疑患有青光眼的人数。计算这些转诊病例的阳性预测值（PPV），并与原始研究结果进行历史比较。
在12个月的数据收集期内，EHEC共评估了376例新的疑似青光眼转诊病例。与初始干预试验中同等的12个月期间相比，转诊人数增加了58%（376例对238例）。PPV维持在0.45（95%可信区间0.41 - 0.51）。
青光眼新转诊病例数的增加以及PPV的维持表明对社区中新发现的青光眼病例数产生了影响。与白内障新转诊病例相比，转诊人数的增加仅限于青光眼。这意味着干预在青光眼检测方面具有针对性效果。我们认为下一步是在另一个地点进行该研究，以查看该效果在其他地方是否可重复。如果情况属实，那么就有一个合理的论据支持广泛采用该策略来改善青光眼病例发现情况。
