title: The Peterborough scheme for community specialist optometrists in glaucoma: results of 4 years of a two-tiered community-based assessment and follow-up service.
abstract: OBJECTIVE
  To report on results of an innovative glaucoma shared-care scheme based in Peterborough, UK.
  
  
  METHODS
  A retrospective review of all new appointments with 11 community-based specialist optometrists in glaucoma (SOG) was conducted. There are two tiers of SOG, whereby tier 2 SOGs have increased levels of autonomy. All optometrist assessments were reviewed by a consultant ophthalmologist, and levels of agreement were calculated for assessment of optic nerve head appearance, Humphrey visual field test interpretation, diagnosis and outcome.
  
  
  RESULTS
  1639 new patients were assessed by SOGs over a 4-year period. The median waiting time for patients from referral to SOG assessment was 0 days (IQR 0-56), and from SOG assessment to consultant review in a virtual clinic was 12 days (IQR 8-18days). After first appointment, over 60% of patients were classified as low-risk and remained within the SOG scheme. Rates of frank disagreement between SOG and consultant regarding diagnosis and proposed outcome were 5.6 and 10.4%, respectively, for tier 2 SOGs and 15.3 and 28.6%, respectively, for tier 1 SOGs.
  
  
  CONCLUSIONS
  The SOG scheme demonstrates acceptable levels of accuracy between SOG and glaucoma consultant. This scheme allows many stable low-risk patients to remain out of hospital eye department outpatient clinics.
authors.affiliation: Eye Department, Peterborough and Stamford NHS Foundation Trust , Peterborough , UK and.
authors.forename: Harry W
authors.initials: HW
authors.lastname: Roberts
authors.forename: Keshma
authors.initials: K
authors.lastname: Rughani
authors.forename: Padmanhaba
authors.initials: P
authors.lastname: Syam
authors.forename: Sumit
authors.initials: S
authors.lastname: Dhingra
authors.forename: Susanna
authors.initials: S
authors.lastname: Ramirez-Florez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000867:Anterior Chamber / Q000473:pathology; D003153:Community Health Services / Q000458:organization & administration / Q000592:standards*; D063171:Corneal Pachymetry; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000175:diagnosis*; D006068:Gonioscopy; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension / Q000175:diagnosis; D009885:Ophthalmology; D009907:Optometry; D010348:Patient Care Team / Q000458:organization & administration / Q000592:standards*; D012017:Referral and Consultation; D012189:Retrospective Studies; D013038:Specialization; D014065:Tonometry, Ocular; D006113:United Kingdom; D058609:Visual Field Tests; D014794:Visual Fields / Q000502:physiology; D014850:Waiting Lists
keywords: Community; glaucoma; optometrist; shared care