目的:及时发现青光眼是预防或延缓视力丧失的关键。这项研究旨在评估验光师常规使用光学相干断层扫描(OCT)检测视神经和视网膜的青光眼变化是否会增加眼科医生的青光眼转诊。
方法:本研究是对来自澳大利亚331个验光实践链的患者常规收集的电子病历的回顾性回顾。
方法:对2019年1月1日至7月31日期间参加纳入实践的每位18-99岁患者的电子病历进行审查。
方法:比较了对所有患者进行常规OCT治疗的青光眼评估的转诊几率(OCT治疗,n=175)且无OCT(非OCT实践,n=20)。眼科医生评估了转诊的一部分,以确定假阳性转诊率。
方法:本研究的主要结果指标是转诊给眼科医生进行青光眼评估。次要结果是假阳性转诊率,在接受青光眼评估的部分患者中进行分析。
结果:纳入了994,461例患者(59%为女性)的记录,纳入了10,475例(1.1%)的青光眼评估。大多数转诊与正常眼内压相关(非OCT实践:n=496,66%;OCT实践:n=6,603,68%)。青光眼的转诊率在OCT实践中(n=9,719,1.1%)高于非OCT实践(n=756,0.8%,年龄-,性别和地点调整后的比值比1.39,95%置信区间1.10-1.76)。在318名转诊患者中(3%,所有来自OCT实践),眼科医生可以获得反馈,68(21%)被认为没有青光眼。
结论:在验光实践中常规使用OCT可能会导致更及时的青光眼检测和预防可避免的视力丧失。
CONCLUSIONS: Optometrists employing OCT as a routine clinical tool have a higher chance of referring patients for specialist glaucoma management than those without OCT.
OBJECTIVE: Timely detection of glaucoma is key to preventing or delaying vision loss. This study aimed to assess whether the routine use of optical coherence tomography (OCT) by
optometrists for the detection of glaucomatous changes in the optic nerve and retina increased glaucoma referrals to ophthalmologists.
METHODS: This study was a retrospective review of routinely collected electronic medical records of patients from a chain of 331 optometry practices in Australia.
METHODS: Electronic medical records were reviewed for every patient aged 18-99 years who attended an included practice between January 1 and July 31, 2019.
METHODS: Odds of referral for glaucoma assessment were compared between practices performing OCT routinely on all patients (OCT practices, n=175) and without OCT (non-OCT practices, n=20). A subset of referrals were assessed by ophthalmologists to determine the false positive referral rate.
METHODS: The primary outcome measure of this study was referral to an ophthalmologist for glaucoma assessment. A secondary outcome was the rate of false positive referrals, analyzed in a subset of patients referred for glaucoma assessment.
RESULTS: Records from 994,461 patients (59% female) were included, and 10,475 (1.1%) were referred for glaucoma assessment. Most referrals were associated with normal intraocular pressure (non-OCT practices: n=496, 66%; OCT practices: n=6,603, 68%). Referral for glaucoma was higher in OCT practices (n=9,719, 1.1%) compared with non-OCT practices (n=756, 0.8%, age-adjusted, gender-adjusted, and location-adjusted odds ratio 1.39, 95% confidence interval 1.10-1.76). Of 318 referred patients (3%, all from OCT practices) for whom ophthalmologist feedback was available, 68 (21%) were considered not to have glaucoma.
CONCLUSIONS: The routine use of OCT in optometric practice may lead to more timely glaucoma detection and prevention of avoidable vision loss.