Tuck M W, Crick R P
International Glaucoma Association, King's College Hospital, London.
BMJ. 1991 Apr 27;302(6783):998-1000. doi: 10.1136/bmj.302.6783.998.
To examine the efficiency of referral for suspected glaucoma to general practitioners and consultants by optometrists.
A prospective survey covering 5% of all sight tests performed by optometrists in England and Wales over six months, with analysis of referred patients.
241 optometrists' practices in areas representative of England and Wales in socioeconomic terms.
Of 275,600 people attending for a sight test, 1505 were referred with suspected glaucoma (0.9% of those aged over 4%). Outcomes were recorded for 1228 patients, 1103 (90%) of whom attended for examination by a consultant ophthalmologist (8% on a private basis). The analysis was confined to the 704 cases in which the information on diagnosis was received directly from a consultant or general practitioner.
Diagnoses reported by consultant ophthalmologists. Waiting times before an appointment for examination by a consultant ophthalmologist.
Glaucoma was confirmed in 283 of the 704 referred patients, and another 222 patients were considered to require further monitoring. In all, 112 (41%) of 275 confirmed cases of glaucoma were in patients with intraocular pressures greater than or equal to 30 mm Hg. At all levels of intraocular pressure the accuracy of referral was greater when the optometrist also recorded the presence of suspicious optic discs or loss of visual field, or both; but only 331 (47%) out of the 704 referred patients had been tested with a field screener. The median waiting time for an NHS clinic appointment was nine weeks. Almost a 10th of confirmed cases of glaucoma were in people in a high risk category for glaucoma who had to wait at least 14 weeks for an appointment.
Closer cooperation, especially at the local level, among consultants, general practitioners, and optometrists is needed to improve testing and referral for suspected glaucoma. Optometrists should be encouraged to perform all the three main tests--ophthalmoscopy, tonometry, and perimetry--in patients before referral and to report precisely on reasons for referral to help prioritisation. The optometrist's referral letter to the general practitioner should always be passed on to the consultant. Similarly, the diagnosis should always be reported back to the optometrist.
研究验光师将疑似青光眼患者转诊给全科医生和专科医生的效率。
一项前瞻性调查，涵盖英格兰和威尔士验光师在六个月内进行的所有视力检查的5%，并对转诊患者进行分析。
241家验光师诊所，这些诊所在社会经济方面代表了英格兰和威尔士的各个地区。
在275,600名接受视力检查的人中，有1505人因疑似青光眼被转诊（占4岁以上人群的0.9%）。记录了1228名患者的结果，其中1103人（90%）前往眼科专科医生处就诊（8%为自费就诊）。分析仅限于直接从专科医生或全科医生处获得诊断信息的704例病例。
眼科专科医生报告的诊断结果。预约眼科专科医生检查前的等待时间。
在704名转诊患者中，283人被确诊为青光眼，另有222名患者被认为需要进一步监测。在275例确诊的青光眼病例中，共有112例（41%）患者的眼压大于或等于30 mmHg。在所有眼压水平上，当验光师还记录了可疑视盘的存在或视野缺损，或两者都记录时，转诊的准确性更高；但在704名转诊患者中，只有331人（47%）接受了视野筛查。国民保健服务（NHS）诊所预约的中位等待时间为九周。近十分之一确诊的青光眼病例是青光眼高危人群，他们必须等待至少14周才能预约就诊。
需要顾问医生、全科医生和验光师之间更密切的合作，特别是在地方层面，以改善疑似青光眼的检测和转诊。应鼓励验光师在转诊前对患者进行所有三项主要检查——检眼镜检查、眼压测量和视野检查，并准确报告转诊原因以帮助确定优先顺序。验光师给全科医生的转诊信应始终转交给顾问医生。同样，诊断结果应始终反馈给验光师。
