title: Attitudes of consultant ophthalmologists in the UK to initial management of glaucoma patients presenting with severe visual field loss: a national survey.
abstract: BACKGROUND
  Recent National Institute of Clinical Excellence guidance suggests primary surgery should be offered to patients presenting with glaucoma with severe visual field loss. We undertook a survey of UK consultant ophthalmologists to determine if this represents current practice and explore attitudes towards managing patients with advanced glaucoma at presentation.
  
  
  METHODS
  Questionnaire evaluation study.
  
  
  METHODS
  All consultant ophthalmologists currently practicing in the UK.
  
  
  METHODS
  A single-page questionnaire was posted to all consultants (n = 910) currently practicing in the UK along with a pre-paid return envelope. A second questionnaire was sent to non-responders (n = 459).
  
  
  METHODS
  Questionnaire responses.
  
  
  RESULTS
  626 responses were received representing 68.8% of the population surveyed. 152 (24%) volunteered a specialist interest in glaucoma. Consensus opinion for both glaucoma specialists (64.9%) and non-glaucoma specialists (62.4%) was to start with primary medical therapy, most commonly citing surgical risk as the primary reason (23% and 22%, respectively) for this approach. Most felt the highest intraocular pressure measurement during follow up (measured in clinic) was the most important variable for prevention of further visual loss (60% of glaucoma specialists and 55% of non-glaucoma specialists). Eighty-three per cent of all responders suggested they would change their practice if evidence supporting primary surgery as a safe and more effective approach existed.
  
  
  CONCLUSIONS
  Recent National Institute of Clinical Excellence guidance does not reflect the current management approach of UK ophthalmologists. The primary concern was related to potential complications of surgery although most practitioners would be willing to change their practice if evidence existed supporting primary surgery in patients presenting with advanced glaucoma.
authors.affiliation: Department of Ophthalmology, Nottingham University NHS Trust, Queens Medical Centre, Nottingham, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Stead
authors.forename: Augusto
authors.initials: A
authors.lastname: Azuara-Blanco
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: King
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D003253:Consultants / Q000706:statistics & numerical data; D005902:Glaucoma, Open-Angle / Q000175:diagnosis* / Q000628:therapy*; D006306:Health Surveys; D006801:Humans; D007429:Intraocular Pressure; D009885:Ophthalmology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014130:Trabeculectomy / Q000706:statistics & numerical data; D006113:United Kingdom; D014786:Vision Disorders / Q000175:diagnosis* / Q000534:rehabilitation; D014794:Visual Fields; D000078329:Workforce
chemical_list: D000959:Antihypertensive Agents