NIHR Biomedical Research Centre for Ophthalmology, UCL Institute of Ophthalmology and Moorfields Eye Hospital NHS Foundation Trust, London, UK.
Ophthalmic Physiol Opt. 2012 Nov;32(6):472-7. doi: 10.1111/j.1475-1313.2012.00943.x. Epub 2012 Sep 26.
To examine if community optometrists follow published guidelines for referral of patients with suspect glaucoma to the hospital eye service.
A retrospective audit of new optometrist-initiated referrals to the Glaucoma Service at Moorfields Eye Hospital, London was performed. Clinical data from referral letters recorded included evidence of intraocular pressure (IOP) measurement and tonometer used. Referral letter information was compared to 2009 guidelines published jointly by the College of Optometrists and Royal College of Ophthalmologists on referring glaucoma suspect patients.
A total of 289 new patients were seen in the Glaucoma Service over a 6 week period from 4th January 2011; a 100% hospital record retrieval rate was obtained. Of these, 114 (39%) were optometrists initiated referrals. Optometrist letters were available for 105 patients. IOP measurements were recorded in 102 (97%); most practitioners used non-contact tonometry (NCT; n = 69; 68%). Practitioners recorded <4 NCT readings per eye (4 readings: n = 3, 4%; 3 readings: n = 42, 61%; 2 readings: n = 6, 9%; 1 reading: n = 18, 26%). Seventy-seven patients (73%) reported with raised IOP as the main referral reason; of these, 33 (43%) were referred with raised IOP in isolation. NCT was the instrument used in the majority of these raised IOP cases (n = 56; 73%). In cases where raised IOP in isolation was the referral reason, 24 (73%) were recorded using NCT; 10 (30%) provided repeat IOP measurement data in the letter. One hundred and two (97%) referred patients attended the hospital appointment. Thirty (29%) were deemed not to have glaucoma, with the remainder diagnosed with ocular hypertension (n = 25; 25%), glaucoma suspect/glaucoma (n = 35, 34%) or narrow angles requiring intervention (n = 12, 12%). Thirty of the 33 patients referred with raised IOP in isolation attended their hospital visit. Ten (33%) of these patients were subsequently discharged. Six (20%) patients had IOP within normal limits when measured with applanation tonometry; all of these patients were kept within the service.
Community optometrists using NCT for measurement should be reminded of the guidelines on number of readings to take and also the value of repeating NCT measures when appropriate. This may help to increase the accuracy of glaucoma suspect referrals to hospital eye service.
调查社区验光师是否遵循发表的指南，将疑似青光眼患者转诊至医院眼科服务。
对伦敦 Moorfields 眼科医院青光眼服务新启动的由验光师发起的转诊进行回顾性审核。转诊信中记录的临床数据包括眼压（IOP）测量和使用的眼压计的证据。转诊信信息与 2009 年由验光师协会和皇家眼科医学院联合发布的关于转诊疑似青光眼患者的指南进行了比较。
2011 年 1 月 4 日至 6 周内，青光眼服务共接待了 289 名新患者，医院记录的检索率为 100%。其中，114 名（39%）是由验光师发起的转诊。可获得 105 名患者的验光师信件。IOP 测量记录在 102 名患者中（97%）；大多数从业者使用非接触眼压计（NCT；n=69；68%）。从业者记录了每只眼的<4 次 NCT 读数（4 次读数：n=3，4%；3 次读数：n=42，61%；2 次读数：n=6，9%；1 次读数：n=18，26%）。77 名患者（73%）因眼压升高作为主要转诊原因就诊；其中 33 名（43%）因眼压升高而单独转诊。在这些眼压升高的病例中，NCT 是大多数情况下使用的仪器（n=56；73%）。在眼压升高单独作为转诊原因的情况下，24 名（73%）记录使用了 NCT；10 名（30%）在信中提供了重复的 IOP 测量数据。102 名转诊患者均参加了医院预约。30 名（29%）被认为没有青光眼，其余患者被诊断为高眼压（n=25；25%）、疑似青光眼/青光眼（n=35，34%）或需要干预的窄角（n=12，12%）。33 名因眼压升高而单独转诊的患者中有 30 名就诊。其中 10 名（33%）患者随后被出院。6 名（20%）患者在用压平眼压计测量时眼压在正常范围内；所有这些患者均在服务范围内。
使用 NCT 进行测量的社区验光师应注意指南中关于应进行的读数次数的说明，并注意在适当情况下重复 NCT 测量的价值。这可能有助于提高疑似青光眼患者转诊至医院眼科服务的准确性。
