title: Agreement between specially trained and accredited optometrists and glaucoma specialist consultant ophthalmologists in their management of glaucoma patients.
abstract: OBJECTIVE
  Optometrists are becoming increasingly involved in the co-management of glaucoma patients as the burden on the Hospital Eye Service continues to escalate. The aim of this study was to assess the agreement between specially trained optometrists and glaucoma-specialist consultant ophthalmologists in their management of glaucoma patients.
  
  
  METHODS
  Four optometrists examined 23-25 patients each and the clinical findings, up to the point of dilation, were documented in the hospital records. The optometrist, and one of two consultant ophthalmologists, then independently examined and documented the optic-disc appearance before recording their decisions regarding the stability and management of the patient on a specially designed proforma. Percentage agreement was calculated together with kappa or weighted kappa statistics, where appropriate.
  
  
  RESULTS
  Agreement between consultants and optometrists in evaluating glaucoma stability was 68.5% (kappa (κ)=0.42-0.50) for visual fields, 64.5% (weighted κ=0.17-0.31) for optic discs, and 84.5% (weighted κ=0.55-0.60) for intraocular pressures. Agreement regarding medical management was 96.5% (κ=0.73-0.81) and for other glaucoma management decisions, including timing of follow-up, referral to a consultant ophthalmologist, and discharge, was 72% (weighted κ=0.65). This agreement increased to 90% following a retrospective independent then consensus review between the two consultants and when qualified agreements were included. Of the 47 glaucoma and non-glaucoma queries generated during the study, 42 resulted in a change of management.
  
  
  CONCLUSIONS
  Confirming the ability of optometrists to make appropriate decisions regarding the stability and management of glaucoma patients is essential if their involvement is to continue to develop to meet the demand of an aging population.
authors.affiliation: Manchester Royal Eye Hospital, Manchester, UK. joanne.marks@cmft.nhs.uk
authors.forename: J R
authors.initials: JR
authors.lastname: Marks
authors.forename: A K
authors.initials: AK
authors.lastname: Harding
authors.forename: R A
authors.initials: RA
authors.lastname: Harper
authors.forename: E
authors.initials: E
authors.lastname: Williams
authors.forename: S
authors.initials: S
authors.lastname: Haque
authors.forename: A F
authors.initials: AF
authors.lastname: Spencer
authors.forename: C
authors.initials: C
authors.lastname: Fenerty
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000008:administration & dosage; D054869:Clinical Audit; D002983:Clinical Competence / Q000592:standards*; D003406:Credentialing; D018463:Filtering Surgery; D005901:Glaucoma / Q000175:diagnosis* / Q000628:therapy; D006302:Health Services Research; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008875:Middle Aged; D009313:National Health Programs; D009885:Ophthalmology / Q000592:standards*; D009898:Optic Disk / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000175:diagnosis* / Q000628:therapy; D009907:Optometry / Q000592:standards*; D018802:Patient-Centered Care; D012017:Referral and Consultation; D012189:Retrospective Studies; D014794:Visual Fields / Q000502:physiology
chemical_list: D000959:Antihypertensive Agents