Br J Ophthalmol 1999;83:707-712 ( June )
The Bristol Shared Care Glaucoma Study: reliability of community
optometric and hospital eye service test measures
P G D Sprya b, I C Spencera, J M Sparrowa, T J Petersc, S T Brookesc, S Grayc, I Bakerd, J E Furbere, D L Eastya
a Department of
Ophthalmology, University of Bristol, Bristol, b Discoveries in Sight, Devers Eye Institute,
Portland, Oregon, USA, c Department of Social Medicine, University of
Bristol, Bristol, d Avon
Health Authority, Bristol, e Bristol Eye Hospital, Bristol
Correspondence to: Dr P G D Spry, Discoveries in Sight,
Devers Eye Institute, Legacy Clinical Research and Technology Center,
1225 NE 2nd Avenue, Portland, Oregon, 97208, USA.
Accepted for publication 18 December 1998
BACKGROUND/AIMS Primary
open angle glaucoma patients and glaucoma suspects make up a
considerable proportion of outpatient ophthalmological attendances and
require lifelong review. Community optometrists can be suitably trained
for assessment of glaucoma. This randomised controlled trial aims to
assess the ability of community optometrists in the monitoring of this
group of patients.
METHODSMeasures of
cup to disc ratio, visual field score, and intraocular pressure
were taken by community optometrists, the hospital eye service and
a research clinic reference "gold" standard in 405 stable glaucoma
patients and ocular hypertensives. Agreement between and within the
three centres was assessed using mean differences and intraclass
correlation coefficients. Tolerance limits for a change in status at
the level of individual pairs of measurements were also calculated.
RESULTSCompared with
a research clinic reference standard, measurements made by community
optometrists and those made in the routine hospital eye service were
similar. Mean measurement differences and variability were similar
across all three groups compared for each of the test variables (IOP,
cup to disc ratio, and visual field). Overall, the visual field was
found to be the most reliable measurement and the cup to disc ratio the least.
CONCLUSIONSTrained
community optometrists are able to make reliable measurements of the
factors important in the assessment of glaucoma patients and glaucoma
suspects. This clinical ability should allow those optometrists with
appropriate training to play a role in the monitoring of suitable patients.
© 1999 by British Journal of Ophthalmology
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