title: Application of clinical techniques relevant for glaucoma assessment by optometrists: concordance with guidelines.
abstract: OBJECTIVE
  Guidelines for the screening, prognosis, diagnosis, management and prevention of glaucoma were released by the Australian National Health and Medical Research Council in 2010. Comparable guidance has been made available by respective bodies in the USA and UK at a similar time. Key to successful translation of guidelines into clinical practice includes clinicians having the necessary skills to perform required tests. Optometrists in Australia and New Zealand were invited to participate in an online survey exploring these aspects. The results provide insights for improving glaucoma diagnosis and management by optometric primary eye care practitioners.
  
  
  METHODS
  An online questionnaire was developed to investigate glaucoma assessment of optometrists as a function of demographic details, educational background and experience. Key points to ascertain compliance with current guidelines were the availability of equipment, procedural confidence in techniques, and preferences in visual field tests. Chi square statistics was employed to support similarity to national averages and highlight differences between the two countries. Multivariate linear regression analysis identified variables significantly associated with individual tests being available to optometrists and their confidence in applying them.
  
  
  RESULTS
  Thirteen per cent of all Australian and 36% of the New Zealand optometrists responded to the survey in 2013, which reflected the demographics/geography of the practising populations. Techniques considered essential or preferred for glaucoma assessment were widely available in both countries with the exception of gonioscopy and pachymetry. After correcting for availability, regression models highlighted therapeutic endorsement and knowledge of glaucoma guidelines as the main variables to maintain high diagnostic confidence. Correlations to number of years in optometric practice mirrored a changed emphasis in teaching and technology over the past 10-15 years.
  
  
  CONCLUSIONS
  Australian and New Zealand optometrists were well equipped to perform glaucoma assessments with the possible exception of gonioscopy. Advanced imaging modalities were not yet fully integrated into optometric practice, although optical coherence tomography has shown use by 23-32% of optometrists. A marked increase in use, availability and procedural confidence of gonioscopy and other techniques with therapeutically endorsed optometrists demonstrates the advantage and importance of additional training.
authors.affiliation: School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; Centre for Eye Health, University of New South Wales, Sydney, Australia; Department of Ophthalmology, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Khalid F
authors.initials: KF
authors.lastname: Jamous
authors.forename: Michael
authors.initials: M
authors.lastname: Kalloniatis
authors.forename: Andrew
authors.initials: A
authors.lastname: Hayen
authors.forename: Paul
authors.initials: P
authors.lastname: Mitchell
authors.forename: Fiona J
authors.initials: FJ
authors.lastname: Stapleton
authors.forename: Barbara
authors.initials: B
authors.lastname: Zangerl
mesh_terms: D001315:Australia; D002983:Clinical Competence; D004522:Educational Status; D005260:Female; D005901:Glaucoma / Q000175:diagnosis*; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D008297:Male; D009520:New Zealand; D009907:Optometry / Q000295:instrumentation / Q000379:methods*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards*; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D041623:Tomography, Optical Coherence; D058609:Visual Field Tests / Q000379:methods
keywords: competence; confidence; glaucoma; optic nerve head; optometrist; visual field