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Deficiencies found in glaucoma care by ODs in retail-based clinics
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A telemedicine project reported poor adherence to the American Academy of Ophthalmology Preferred Practice Patterns guidelines for primary open angle glaucoma and primary open angle glaucoma suspect care by optometrists practicing in retail-based clinics.
In underserved areas of the U.S., such as Alabama, optometrists practicing in retail-based clinics are the most accessible eye care providers, the authors said.
Primary open angle glaucoma (POAG) and suspected primary open angle glaucoma (POAGS) have a high prevalence there due the high number of residents of African origin, with diabetes and of older age.
The aim of the telemedicine project was to evaluate the practice habits of retail-based optometrists, particularly concerning compliance with the American Academy of Ophthalmology Preferred Practice Patterns (AAO PPP). The guidelines include five elements related to history taking and nine elements related to ocular examination. The final element is related to management and consists of setting a target IOP.
Overall, there was excellent adherence to 10 of the 15 PPP elements, documented in more than 98% of the patients. Dilated fundus examination, central corneal thickness and visual field were performed in 80% to 90% of the patients, while gonioscopy was documented in less than half, and setting a target IOP was performed in only a small percentage.
“This study supports the growing body of literature highlighting key deficiencies in glaucoma care likely to reduce clinicians’ ability to detect potentially blinding progressive glaucomatous injury,” the authors wrote.
Providers were aware to be participating in a telemedicine project, and, therefore, these practice patterns are likely a “best case scenario” of community optometrists, they noted.
Given the growth of the aging population, an increasing number of people will rely in the future on primary eye care providers such as optometrists in retail-based clinics. It is, therefore, important to monitor and stress compliance with the PPP among all providers, they concluded. – by Michela Cimberle
Disclosure: The authors reported no relevant financial disclosures.
Perspective
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Andrew Rixon, OD, FAAO
Because this study has a total sample size of two providers, it provides little insight into optometric delivery of glaucoma care. The findings are, however, consistent with prior studies that suggest glaucoma preferred practice patterns are not unanimously adhered to by the majority of front-line eye care providers, regardless of their degree or practice modality (Hertzog et al., Mihlstin et al., Coleman et al., Zebardast et al., Solano-Moncada et al.). Specifically, documentation of gonioscopy and target IOP was not consistently achieved, similar to what has been reported in prior studies.
As highlighted in this study, with an aging population with associated increasing prevalence of glaucoma, a limited supply of glaucoma subspecialists and location-based access to care issues, optometry will increasingly encounter a substantial percentage of glaucoma patients in the U.S.
Open-angle glaucoma guidelines from the American Academy of Ophthalmology and American Optometric Association have existed since 1989 and 1998, respectively, with both developed to maximize evidence-based care, and they are easily and freely accessible (links provided below). Thirty years later, both optometry and ophthalmology regrettably employ gonioscopy just 50% of the time.
Foundationally, all optometrists and ophthalmologists should embrace glaucoma preferred practice patterns in their day-to-day clinical care to help accurately classify and manage glaucoma as the prevalence of this disease increases.
References:
American Academy of Ophthalmology. Primary Open-Angle Glaucoma Preferred Practice Pattern. https://www.aao.org/preferred-practice-pattern/primary-open-angle-glaucoma-ppp-2015. Updated June 2018. Accessed January 16, 2019.
American Optometric Association. Optometric Clinical Practice Guideline: Care of the Patient with Open Angle Glaucoma. https://www.aoa.org/documents/optometrists/CPG-9.pdf. Revised 2010. Accessed January 16, 2019.
Coleman AL, et al. J Glaucoma. 2006;doi:10.1097/01.ijg.0000212287.62798.8f.
Hertzog LH, et al. Ophthalmology. 1996;103:1009-1013.
Mihlstin M, et al. J Glaucoma. 2016;doi:10.1097/IJG.0000000000000548.
Zebardast N, et al. BMC Ophthalmology. 2015;doi:10.1186/s12886-015-0027-x.
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