Optometry practices with OCT more likely to refer patients for glaucoma assessment
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Key takeaways:
- Patients aged younger than 40 years were more likely to be referred to an ophthalmologist by optometry practices with OCT.
- Two-thirds of patients referred for suspected glaucoma had IOP in the normal range.
Optometry practices with OCT were more likely to refer patients to an ophthalmologist for suspected glaucoma than practices without OCT, according to a study published in Journal of Glaucoma.
“Early detection of glaucoma is key to preserving visual function and quality of life,” Joseph P. Paul, PhD, head of professional services at Specsavers Australia and New Zealand, and colleagues wrote. “Despite the well-established role of OCT in glaucoma diagnosis in ophthalmology, its use is not ubiquitous in optometric practice. OCT is typically used by optometrists as an on-indication investigation.”
To evaluate what they called a “paradigm shift” in the use of OCT from an on-indication diagnostic test to a routine case-finding test, Paul and colleagues compared glaucoma detection rates among patients from optometry practices with and without OCT devices.
The retrospective review included records from 994,461 patients (59% women; median age, 52 years; interquartile range [IQR], 38-65 years) who visited optometry practices in Australia between Jan. 1 and July 31, 2019. There were 195 practices included in the study — 170 with OCT and 25 without.
According to results, optometrists referred 10,475 patients (1.1%; 53% women; median age, 66 years; IQR, 56-73) to an ophthalmologist for glaucoma assessment. Practices with OCT were more likely to refer patients for suspected glaucoma than practices without OCT (1.1% vs. 0.8%; adjusted OR = 1.39).
The rate of referral “increased dramatically” among older patients (aOR per year increase = 1.05), but patients aged younger than 40 years were more likely to be referred for glaucoma assessment from practices that used OCT (OR = 1.92).
Two-thirds (68%) of patients referred to ophthalmologists had IOP of 21 mm Hg or lower in both eyes. Among younger patients, those from OCT practices were more likely to have normal IOP than patients from non-OCT practices (66% vs. 47%; OR = 2.2). Researchers found no significant difference in the odds of having a normal IOP among older patients based on OCT use.
Ophthalmologists provided feedback for 318 patients, of whom 129 (41%) were diagnosed with glaucoma, 121 (38%) were suspected to have glaucoma and 68 (21%) were determined to not have glaucoma.
Among patients diagnosed with or suspected to have glaucoma, 63% had normal IOP. There were no differences in the proportion of patients without glaucoma based on use of OCT, IOP range or patient sex.
“We found that Australian optometric practices that employed OCT technology exhibited a 34% higher odds of referring patients for ophthalmologists’ evaluation of glaucoma compared with practices without OCT devices,” the researchers wrote. “This study suggests that the routine inclusion of OCT imaging increases the detection of glaucoma by optometrists.
“Adoption of OCT as a routine clinical tool in optometry, rather than an on-indication test, may significantly reduce the burden of undiagnosed glaucoma in the population and ultimately lead to improved visual outcomes.”
Perspective
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Glaucoma is one of the leading causes of irreversible blindness, with prevalence between 2% and 3% worldwide. Early detection of this “silent thief of sight” is vital to preserving visual function and quality of life, yet it has been estimated that more than 70% of affected people remain undiagnosed.
Through this retrospective review of records from an optical chain in Australia, Paul and colleagues found that inclusion of OCT images during routine examinations increased the detection of glaucoma and subsequently increased glaucoma-related referrals by 34%. Of these referrals, 41% of these patients were diagnosed with glaucoma, 38% were considered glaucoma suspects and 21% were determined not to be glaucomatous.
These data merely confirm what we know about optometrists and their important role in primary eye care. With an aging population and the increased need for quality eye care, we should be empowering our colleagues on the front lines to have the clinical knowledge base and appropriate technology available, so they can not only run the testing but also make this critical, vision-saving diagnosis.
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Paul JP, et al. J Glaucoma. 2024;doi:10.1097/IJG.0000000000002339.
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