دورية أكاديمية
Outcomes of newly referred patients with suspected angle closure: do we need to redefine the clinical pathways?
| العنوان: | Outcomes of newly referred patients with suspected angle closure: do we need to redefine the clinical pathways? |
|---|---|
| المؤلفون: | Founti P; Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK. pfounti@gmail.com.; School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece. pfounti@gmail.com., Narayan A; Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK., Raja A; Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK., Nathwani N; Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK., Tur SB; Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK., Thomas R; Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK., Scott A; Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK., Martins A; Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK.; Save Sight Institute, Discipline of Ophthalmology and Eye Health, University of Sydney, Sydney, NSW, Australia., Nolan W; Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK.; National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Moorfields and UCL Institute of Ophthalmology, London, UK. |
| المصدر: | Eye (London, England) [Eye (Lond)] 2024 Feb; Vol. 38 (3), pp. 514-519. Date of Electronic Publication: 2023 Sep 08. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Nature Publishing Group Country of Publication: England NLM ID: 8703986 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1476-5454 (Electronic) Linking ISSN: 0950222X NLM ISO Abbreviation: Eye (Lond) Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: <2003->: London : Nature Publishing Group Original Publication: [London : Ophthalmological Society of the United Kingdom, 1987- |
| مواضيع طبية MeSH: | Glaucoma, Angle-Closure*/diagnosis , Glaucoma*, Humans ; Critical Pathways ; Retrospective Studies ; Intraocular Pressure ; Prospective Studies ; Tomography, Optical Coherence/methods ; Gonioscopy ; Anterior Eye Segment ; Iris |
| مستخلص: | Background/objectives: To investigate outcomes of referrals for suspected angle closure and explore whether anterior segment optical coherence tomography (AS-OCT) can be used to tighten triaging criteria in a glaucoma virtual clinic. Subjects/methods: Retrospectively collected data. The first audit (04/2018-03/2019) identified referrals for suspected angle closure without other glaucoma-related findings (primary angle closure suspect (PACS) referrals). All patients underwent gonioscopy. The second audit (04-08/2019) identified patients with suspected angle closure in a virtual clinic. Management outcomes were assessed, using gonioscopy as reference standard. The outcomes of the second audit were re-audited after changing the triaging criterion from angle width <10° to iridotrabecular contact (ITC) in ≥1 quadrants on AS-OCT. Results: Out of 1754 glaucoma referrals (first audit), 24.6% (431/1754) were PACS referrals. Of these, only 10.7% (42/393) had an occludable angle on gonioscopy, with 97.6% (41/42) being PACS. Of these, 78% (32/41) underwent laser peripheral iridotomy. Out of 137 referrals in the virtual clinic (second audit), 66.4% (91/137) were triaged to the face-to-face clinic. Of these, 31.9% (29/91) were discharged. AS-OCT had positive and negative predictive value of 74.3% (95% confidence intervals (CI) 57.8-86.0) and 82.1% (95% CI 70.0-90.2%), respectively, in detecting ITC in ≥1 quadrants. In the re-audit 45.9% (45/98) of those with suspected angle closure were triaged for gonioscopy, with 24.4% (11/45) of them being discharged. Conclusion: PACS referrals represent a substantial burden to hospital-based services and their accuracy is low. ITC in ≥1 quadrants on AS-OCT can be useful in triaging those who need further evaluation with gonioscopy. (© 2023. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.) |
| References: | NICE guidance for angle closure (Last revised in February 2023) [Available from: https://cks.nice.org.uk/topics/glaucoma/management/acute-angle-closure-angle-closure-glaucoma/ . Azuara-Blanco A, Burr J, Ramsay C, Cooper D, Foster PJ, Friedman DS, et al. Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial. Lancet. 2016;388:1389–97. (PMID: 10.1016/S0140-6736(16)30956-427707497) He M, Jiang Y, Huang S, Chang DS, Munoz B, Aung T, et al. Laser peripheral iridotomy for the prevention of angle closure: a single-centre, randomised controlled trial. Lancet. 2019;393:1609–18. (PMID: 10.1016/S0140-6736(18)32607-230878226) The Royal College of Ophthalmologists. Clinical Guidelines. The Management of Angle-Closure Glaucoma 2022 [Available from: https://www.rcophth.ac.uk/resources-listing/management-of-angle-closure-glaucoma-guideline/ . Simons AS, Vercauteren J, Barbosa-Breda J, Stalmans I. Shared care and virtual clinics for glaucoma in a hospital setting. J Clin Med. 2021;10:4785. Lawal AK, Rotter T, Kinsman L, Machotta A, Ronellenfitsch U, Scott SD, et al. What is a clinical pathway? Refinement of an operational definition to identify clinical pathway studies for a Cochrane systematic review. BMC Med. 2016;14:35. (PMID: 10.1186/s12916-016-0580-z269049774765053) Burton MJ, Ramke J, Marques AP, Bourne RRA, Congdon N, Jones I, et al. The Lancet Global Health Commission on Global Eye Health: vision beyond 2020. Lancet Glob Health. 2021;9:e489–e551. (PMID: 10.1016/S2214-109X(20)30488-5336070167966694) Radhakrishnan S, Rollins AM, Roth JE, Yazdanfar S, Westphal V, Bardenstein DS, et al. Real-time optical coherence tomography of the anterior segment at 1310 nm. Arch Ophthalmol. 2001;119:1179–85. (PMID: 10.1001/archopht.119.8.117911483086) Van Herick W, Shaffer RN, Schwartz A. Estimation of width of angle of anterior chamber. Incidence and significance of the narrow angle. Am J Ophthalmol. 1969;68:626–9. (PMID: 10.1016/0002-9394(69)91241-05344324) Shaffer RN, Schwartz A. Gonioscopy. Surv Ophthalmol. 1957;2:389–409. (PMID: 13486432) Friedman DS. Angle closure and angle closure glaucoma: reports and consensus statements of the 3rd global aigs consensus meeting on angle closure glaucoma: The Hague, The Netherlands: Kugler Publications; 2006. Becker BSR Diagnosis and Therapy of the Glaucomas: C.V. Mosby; 1965. Nolan WP, See JL, Chew PT, Friedman DS, Smith SD, Radhakrishnan S, et al. Detection of primary angle closure using anterior segment optical coherence tomography in Asian eyes. Ophthalmology. 2007;114:33–9. (PMID: 10.1016/j.ophtha.2006.05.07317070597) Annoh R, Loo CY, Hogan B, Tan HL, Tang LS, Tatham AJ. Accuracy of detection of patients with narrow angles by community optometrists in Scotland. Ophthalmic Physiol Opt. 2019;39:104–12. (PMID: 10.1111/opo.1260130600544) Government GosGTS. https://www.sehd.scot.nhs.uk/pca/PCA2022(O)01.pdf [General ophthalmic services (GOS). The Scottish Government]. Bowling B, Chen SD, Salmon JF. Outcomes of referrals by community optometrists to a hospital glaucoma service. Br J Ophthalmol. 2005;89:1102–4. (PMID: 10.1136/bjo.2004.064378161133581772809) Tuck MW, Crick RP. Efficiency of referral for suspected glaucoma. BMJ. 1991;302:998–1000. (PMID: 10.1136/bmj.302.6783.99820398991669315) Sheldrick JH, Ng C, Austin DJ, Rosenthal AR. An analysis of referral routes and diagnostic accuracy in cases of suspected glaucoma. Ophthalmic Epidemiol. 1994;1:31–9. (PMID: 10.3109/092865894090714438790611) Vernon SA, Ghosh G. Do locally agreed guidelines for optometrists concerning the referral of glaucoma suspects influence referral practice? Eye (Lond). 2001;15:458–63. (PMID: 10.1038/eye.2001.15511767019) Theodossiades J, Murdoch I, Cousens S. Glaucoma case finding: a cluster-randomised intervention trial. Eye (Lond). 2004;18:483–90. (PMID: 10.1038/sj.eye.670067615131679) Lockwood AJ, Kirwan JF, Ashleigh Z. Optometrists referrals for glaucoma assessment: a prospective survey of clinical data and outcomes. Eye (Lond). 2010;24:1515–9. (PMID: 10.1038/eye.2010.7720559331) Shah S, Murdoch IE. NICE - impact on glaucoma case detection. Ophthalmic Physiol Opt. 2011;31:339–42. (PMID: 10.1111/j.1475-1313.2011.00843.x21545475) Founti P, Topouzis F, Holló G, Cvenkel B, Iester M, Haidich AB, et al. Prospective study of glaucoma referrals across Europe: are we using resources wisely? Br J Ophthalmol. 2018;102:329–37. (PMID: 10.1136/bjophthalmol-2017-31024928774936) Khan S, Clarke J, Kotecha A. Comparison of optometrist glaucoma referrals against published guidelines. Ophthalmic Physiol Opt. 2012;32:472–7. (PMID: 10.1111/j.1475-1313.2012.00943.x23009293) Landgren K, Peters D. A prospective study on effectiveness of elevated intraocular pressure as a criterion for glaucoma referrals by optometric practitioners in Sweden. Acta Ophthalmol. 2021;99:e1098–e105. (PMID: 10.1111/aos.14764334233988596777) Nilsson AG, Peters D. Effectiveness of elevated intraocular pressure as a criterion for glaucoma referral after 6 years of follow-up. Clin Ophthalmol. 2021;15:3041–9. (PMID: 10.2147/OPTH.S318068342951438291828) Huang J, Yapp M, Hennessy MP, Ly A, Masselos K, Agar A, et al. Impact of referral refinement on management of glaucoma suspects in Australia. Clin Exp Optom. 2020;103:675–83. (PMID: 10.1111/cxo.1303031852027) The College of Optometrists. Clinical Management Guidelines [Available from: https://www.college-optometrists.org/clinical-guidance/clinical-management-guidelines/primaryangleclosure_primaryangleclosureglaucoma_pa . The Scottish Intercollegiate Guidelines Network (SIGN) 2015 [Available from: https://www.sign.ac.uk/our-guidelines/glaucoma-referral-and-safe-discharge/ . Jindal A, Ctori I, Virgili G, Lucenteforte E, Lawrenson JG. Non-contact tests for identifying people at risk of primary angle closure glaucoma. Cochrane Database Syst Rev. 2020;5:Cd012947. (PMID: 32468576) Azuara-Blanco A. Cochrane corner: non-contact tests for identifying people at risk of primary angle closure glaucoma. Eye (Lond). 2021;35:1048–9. (PMID: 10.1038/s41433-020-1092-932678346) Foster PJ, Devereux JG, Alsbirk PH, Lee PS, Uranchimeg D, Machin D, et al. Detection of gonioscopically occludable angles and primary angle closure glaucoma by estimation of limbal chamber depth in Asians: modified grading scheme. Br J Ophthalmol. 2000;84:186–92. (PMID: 10.1136/bjo.84.2.186106551961723375) Day AC, Baio G, Gazzard G, Bunce C, Azuara-Blanco A, Munoz B, et al. The prevalence of primary angle closure glaucoma in European derived populations: a systematic review. Br J Ophthalmol. 2012;96:1162–7. (PMID: 10.1136/bjophthalmol-2011-30118922653314) Porporato N, Baskaran M, Tun TA, Sultana R, Tan M, Quah JH, et al. Understanding diagnostic disagreement in angle closure assessment between anterior segment optical coherence tomography and gonioscopy. Br J Ophthalmol. 2020;104:795–9. (PMID: 10.1136/bjophthalmol-2019-31467231492674) Radhakrishnan S, Chen PP, Junk AK, Nouri-Mahdavi K, Chen TC. Laser Peripheral Iridotomy in Primary Angle Closure: A Report by the American Academy of Ophthalmology. Ophthalmology. 2018;125:1110–20. (PMID: 10.1016/j.ophtha.2018.01.015) The Royal College of Ophthalmologists. The Way Forward 2017 [Available from: https://www.rcophth.ac.uk/standardspublications-research/the-way-forward/ . Sakata LM, Lavanya R, Friedman DS, Aung HT, Seah SK, Foster PJ, et al. Assessment of the scleral spur in anterior segment optical coherence tomography images. Arch Ophthalmol. 2008;126:181–5. (PMID: 10.1001/archophthalmol.2007.4618268207) Wong HT, Chua JL, Sakata LM, Wong MH, Aung HT, Aung T. Comparison of slitlamp optical coherence tomography and scanning peripheral anterior chamber depth analyzer to evaluate angle closure in Asian eyes. Arch Ophthalmol. 2009;127:599–603. (PMID: 10.1001/archophthalmol.2009.4119433707) Sakata LM, Lavanya R, Friedman DS, Aung HT, Gao H, Kumar RS, et al. Comparison of gonioscopy and anterior segment ocular coherence tomography in detecting angle closure in different quadrants of the anterior chamber angle. Ophthalmology. 2008;115:769–74. (PMID: 10.1016/j.ophtha.2007.06.03017916377) Narayanaswamy A, Sakata LM, He M-G, Friedman DS, Chan Y-H, Lavanya R, et al. Diagnostic performance of anterior chamber angle measurements for detecting eyes with narrow angles: an anterior segment OCT study. Arch Ophthalmol. 2010;128:1321–7. (PMID: 10.1001/archophthalmol.2010.23120938002) European Glaucoma Society. Terminology and Guidelines for Glaucoma. 5th Edition: PubliComm, Savona, Italy 2020. Gedde SJ, Chen PP, Muir KW, Vinod K, Lind JT, Wright MM, et al. Primary angle-closure disease preferred practice pattern®. Ophthalmology. 2021;128:P30–70. (PMID: 10.1016/j.ophtha.2020.10.02134933744) Asia Pacific Glaucoma Society. Glaucoma Guidelines. 3rd Edition. Amsterdam, The Netherlands: Kugler Publications; 2016. Ho YF, Hu FC, Lee PI. The advantages and challenges of using real-world data for patient care. Clin Transl Sci. 2020;13:4–7. (PMID: 10.1111/cts.1268331456349) US Food and Drug Administration. Real-World Evidence 2022 [Available from: https://www.fda.gov/science-research/science-and-research-special-topics/real-world-evidence . |
| تواريخ الأحداث: | Date Created: 20230908 Date Completed: 20240214 Latest Revision: 20240214 |
| رمز التحديث: | 20240214 |
| مُعرف محوري في PubMed: | PMC10858203 |
| DOI: | 10.1038/s41433-023-02713-7 |
| PMID: | 37684375 |
| قاعدة البيانات: | MEDLINE |
Find this article in full text from Springer Verlag. 
Full Text Finder | تدمد: | 1476-5454 |
|---|---|
| DOI: | 10.1038/s41433-023-02713-7 |