Table 1
Demographic details of the study patients.
| Characteristic | Total sample (n = 266) | Ophthalmology-led care group (n = 81) | Shared care group (n = 185) | P-value |
|---|---|---|---|---|
| Age, years | ||||
| Mean (SD) | 62 (12) | 60 (13) | 62 (12) | 0.276 |
| Range | 23–86 | 23–86 | 25–86 | |
| Sex, n (%) | ||||
| Male | 170 (64%) | 53 (65%) | 117 (63%) | 0.782 |
| Female | 96 (36%) | 28 (35%) | 68 (37%) | |
| Ethnicity, n (%) | ||||
| Caucasian | 150 (56%) | 46 (57%) | 104 (56%) | 0.894 |
| Asian | 83 (31%) | 24 (30%) | 59 (32%) | |
| Other† | 33 (12%) | 11 (14%) | 22 (12%) | |
| Baseline refraction‡ | ||||
| Spherical equivalent, mean (SD) | –0.7 (2.5) | –1.0 (2.7) | –0.6 (2.5) | 0.742 |
| Myopia < –1, n (%) | 87 (34%) | 24 (32%) | 63 (35%) | 0.667 |
| Myopia < –3, n (%) | 42 (16%) | 16 (21%) | 26 (14%) | 0.196 |
| Baseline maximum IOP in both eyes, mmHg | ||||
| Mean (SD) | 19 (5) | 20 (5) | 19 (5) | 0.070 |
| Range | 8–34 | 10–34 | 8–33 | |
| IOP ≥ 22 | 78 (29%) | 30 (37%) | 48 (26%) | 0.079 |
| IOP < 22 | 188 (71%) | 51 (63%) | 137 (74%) | |
| Baseline thinnest CCT in both eyes, µm | ||||
| Mean (SD) | 548 (34) | 547 (36) | 549 (33) | 0.381 |
| Range | 452–656 | 452–635 | 454–656 | |
| CCT < 555 | 151 (57%) | 48 (59%) | 103 (56%) | 0.687 |
| CCT ≥ 555 | 115 (43%) | 33 (41%) | 82 (44%) | |
| Baseline glaucoma severity§ | ||||
| Suspect or OHT | 110 (43%) | 20 (26%) | 90 (51%) | <0.001*** |
| Early | 89 (35%) | 22 (29%) | 67 (38%) | |
| Moderate | 10 (4%) | 6 (8%) | 4 (2%) | |
| Advanced | 46 (18%) | 29 (38%) | 17 (10%) | |
| Primary prescribed therapy, n (%) | ||||
| Prostaglandin analogue | 112 (68%) | 38 (61%) | 74 (72%) | 0.475 |
| Laser (SLT or PI) | 23 (14%) | 9 (15%) | 14 (14%) | |
| Alpha-agonist | 3 (2%) | 1 (2%) | 2 (2%) | |
| Beta-blocker | 3 (2%) | 1 (2%) | 2 (2%) | |
| Combination | 24 (15%) | 13 (21%) | 11 (11%) | |
| Initial recommended review period¶ | ||||
| <3 months | 108 (47%) | 38 (54%) | 70 (44%) | 0.061 |
| 3–5 months | 30 (13%) | 13 (19%) | 17 (11%) | |
| 6–8 months | 83 (36%) | 17 (24%) | 66 (42%) | |
| 9–12 months | 7 (3%) | 2 (3%) | 5 (3%) | |
[i] † Includes four individuals of African descent.
‡ Missing values: 11.
§ Missing values: 12.
¶ Missing values: 38; Advanced glaucoma was defined as a visual field mean deviation worse than –12dB, or three or more points with an abnormal probability score of less than 2% within the central ten degrees. Further data on the severity of visual field defects using mean deviation alone is presented in Figure 2D.
Abbreviations: CCT, central corneal thickness; IOP, intraocular pressure; OHT, ocular hypertension; PI, peripheral iridotomy; SD, standard deviation; SLT, selective laser trabeculoplasty.
Figure 1
Distribution of all patients enrolled in the scheme. Patients were categorised as suitable for shared care if at least one of their follow up consultations over the three-year study period was conducted in the optometry-led clinic.
Abbreviations: GMC, glaucoma management clinic.
Figure 2
Key differences between the groups of patients suitable and unsuitable for shared care: A) The blue and green vertical dotted lines indicate the median of 5 and 6 visits for the ophthalmology-led care only and shared care groups, respectively. B) Baseline diagnosis and C) Management across the two groups D) Patients in ophthalmology-led care showed a poorer worse eye Humphrey visual fields mean deviation median (interquartile range) of –3.70 (5.19) dB compared to –1.58 (3.18) dB for the shared care group.
Abbreviations: dB, decibels; NTG, normal tension glaucoma; OHT, ocular hypertension; POAG, primary open angle glaucoma; SOAG, secondary open angle glaucoma.
Figure 3
Flowchart illustrating the direction of patient flow across all 1,490 attendances required for the 266 patients included in the study. Almost half (46%) of all follow up assessments were seen by optometrists only; either in optometry-led clinic or as a short subsequent consultation. Based on follow up attendances only, the re-referral rate to ophthalmology in the GMC was 21% (260 attendances).
Abbreviations: GMC, glaucoma management clinic.
Table 2
Cross tabulation of the diagnosis versus action plan across all appointments where a specific review period was applicable (n = 1,348).
| Diagnosis | Treated | Management plan | Recommended review period | ||||
|---|---|---|---|---|---|---|---|
| <3 months | 3–5 months | 6–8 months | 9–12 months | Total | |||
| Suspect | Untreated | Stop treatment | 10 | 3 | 1 | 0 | 14 |
| No treatment | 9 | 41 | 137 | 60 | 247 | ||
| Treated | Start treatment | 1 | 0 | 0 | 0 | 1 | |
| Continue treatment | 0 | 2 | 17 | 3 | 22 | ||
| OHT | Untreated | Stop treatment | 1 | 1 | 0 | 0 | 2 |
| No treatment | 3 | 16 | 52 | 13 | 84 | ||
| Treated | Start treatment | 4 | 0 | 2 | 0 | 6 | |
| Continue treatment | 1 | 5 | 24 | 0 | 30 | ||
| Change treatment | 2 | 0 | 0 | 0 | 2 | ||
| NTG | Untreated | No treatment | 1 | 0 | 0 | 0 | 1 |
| Treated | Start treatment | 49 | 2 | 1 | 0 | 52 | |
| Continue treatment | 19 | 94 | 310 | 3 | 426 | ||
| Change treatment | 45 | 9 | 5 | 0 | 59 | ||
| POAG | Untreated | Stop treatment | 1 | 1 | 0 | 0 | 2 |
| No treatment | 1 | 2 | 0 | 0 | 3 | ||
| Treated | Start treatment | 37 | 2 | 0 | 0 | 39 | |
| Continue treatment | 17 | 63 | 158 | 1 | 239 | ||
| Change treatment | 37 | 4 | 5 | 0 | 46 | ||
| SOAG | Treated | Start treatment | 5 | 1 | 0 | 0 | 6 |
| Continue treatment | 5 | 14 | 37 | 0 | 56 | ||
| Change treatment | 8 | 1 | 2 | 0 | 11 | ||
| 1348 | |||||||
[i] Abbreviations: NTG, normal tension glaucoma; OHT, ocular hypertension; POAG, primary open angle glaucoma; SOAG, secondary open angle glaucoma.
Figure 4
Frequency histograms for the key outcome measures of the study: there was no statistically significant difference between the ophthalmology-led care and shared care groups in A) timeliness of follow up appointments, after removing outliers, B) change in IOP with treatment, or C) visual fields mean deviation progression rates among the worse eye. Shaded in green are 7 subjects that showed a fast visual fields mean deviation progression rate (worse than –1dB/year).
Abbreviations: IOP, intraocular pressure.