title: Glaucoma detection: the content of optometric eye examinations for a presbyopic patient of African racial descent.
abstract: OBJECTIVE
  Standardised patient (SP) methodology is the gold standard for evaluating clinical practice. We investigated the content of optometric eyecare for an early presbyopic SP of African racial descent, an "at-risk" patient group for primary open-angle glaucoma (POAG).
  
  
  METHODS
  A trained actor presented unannounced as a 44-year-old patient of African racial descent, complaining of recent near vision difficulties, to 100 community optometrists for an audio-recorded eye examination. The eye examinations were subsequently assessed via a checklist based on evidence-based POAG reviews, clinical guidelines and expert panel opinion.
  
  
  RESULTS
  Ninety-five per cent of optometrists carried out optic disc assessment and tonometry, which conforms to the UK College of Optometrists' advice that those patients aged >40 years should receive at least two of the following tests: tonometry, optic disc assessment, visual field testing. Thirty-five per cent of optometrists carried out all of these tests and 6% advised the SP of increased POAG risk in those of African racial descent.
  
  
  CONCLUSIONS
  SP encounters are an effective measure of optometric clinical practice. As in other healthcare disciplines, there are substantial differences between optometrists in the depth of their clinical investigations, challenging the concept of a "standard sight test". There is a need for continuing professional development (CPD) in glaucoma screening, in which the increased risk of POAG in those of African racial descent should be emphasised.
authors.affiliation: The Neville Chappell Research Clinic, The Institute of Optometry, 56-62 Newington Causeway, London SE1 6DS, UK. rakhee19@gmail.com
authors.forename: R
authors.initials: R
authors.lastname: Shah
authors.forename: D F
authors.initials: DF
authors.lastname: Edgar
authors.forename: P G
authors.initials: PG
authors.lastname: Spry
authors.forename: R A
authors.initials: RA
authors.lastname: Harper
authors.forename: A
authors.initials: A
authors.lastname: Kotecha
authors.forename: S
authors.initials: S
authors.lastname: Rughani
authors.forename: B J W
authors.initials: BJ
authors.lastname: Evans
mesh_terms: D000328:Adult; D044383:Black People; D003153:Community Health Services / Q000379:methods / Q000592:standards; D003941:Diagnostic Techniques, Ophthalmological / Q000592:standards; D042241:Early Diagnosis; D004739:England; D005902:Glaucoma, Open-Angle / Q000150:complications / Q000175:diagnosis* / Q000208:ethnology; D006801:Humans; D008487:Medical History Taking / Q000592:standards; D009887:Ophthalmoscopy / Q000706:statistics & numerical data; D009907:Optometry / Q000379:methods / Q000592:standards*; D016544:Patient Simulation; D017410:Practice Guidelines as Topic; D011305:Presbyopia / Q000208:ethnology / Q000209:etiology*; D012307:Risk Factors; D014065:Tonometry, Ocular / Q000706:statistics & numerical data