Utility of optometrist referrals for glaucoma evaluation in a young adult population.

CLINICAL RELEVANCE

Few studies have examined the utility of glaucoma referrals among young adults aged 18-40 years, as glaucoma is primarily a disease of the elderly. There are sparse data about prevalence of myopia, which may confound glaucoma diagnosis in this population.

BACKGROUND

To examine the prevalence and characteristics of primary open angle glaucoma (POAG) patients and suspects among young adults aged 18-39 years referred by optometry for in-office evaluation by glaucoma specialists.

METHODS

Eligible participants who were referred for glaucoma evaluation between 1 January 2015 to 31 December 2019 were identified in the electronic medical record database. Study inclusion required glaucoma suspect diagnosis by optometry with subsequent referral and evaluation by a fellowship-trained glaucoma specialist. Diagnoses of glaucoma suspect and POAG by the glaucoma specialists were ascertained through International Classification of Diseases Tenth Revision codes and confirmed through manual chart review. Electronic medical record data were reviewed for age at time of referral, sex, cup-to-disc ratio, intraocular pressure (IOP), central corneal thickness, spherical equivalent refractive error, and family history of glaucoma. Ocular data from one eye of each included patient was selected at random and compared between glaucoma suspects and glaucoma patients.

RESULTS

Among 660 patients referred by optometrists for glaucoma evaluation, 151 (22.9%) followed up with referrals. Among evaluated patients, 6 (4.0%) were diagnosed with glaucoma. Glaucoma patients tended to have more severe myopia and higher cup-to-disc ratio compared to glaucoma suspects.

CONCLUSION

The utility of referring young adults for glaucoma evaluation was low in this patient population and practice setting, with only one out of 25 evaluations yielding a positive diagnosis and over 75% of referred patients failing to present for evaluation. Evidence-based methods to risk-stratify patients and establish standardised referral guidelines could be beneficial to ensure proper allocation of glaucoma care resources.