Compliance with Primary Open-Angle Glaucoma and Primary Open-Angle Glaucoma Suspect Preferred Practice Patterns in a Retail-Based Eye Clinic.

Compliance with Primary Open-Angle Glaucoma and Primary Open-Angle Glaucoma Suspect Preferred Practice Patterns in a Retail-Based Eye Clinic.

J Glaucoma. 2018 Sep 18;:

Authors: Stanley J, Huisingh CE, Swain TA, McGwin G, Owsley C, Girkin CA, Rhodes LA

Abstract
PURPOSE: To determine the level of adherence to the American Academy of Ophthalmology (AAO) preferred practice pattern (PPP) guidelines for quality primary open angle glaucoma (POAG) and POAG suspect (POAGS) care among retail-based optometrists.
METHODS: Patients with a diagnosis of POAG or POAGS who participated in a telemedicine pilot project were included. Patients' charts were evaluated for 15 elements of PPP guidelines for glaucoma care. Results were further stratified by number of follow-up visits and diagnosis.
RESULTS: Of 360 identified patients, ten elements were documented in over 98%. Documentation of the remaining five components was as follows: dilated fundus exam (DFE) 91.1%, central corneal thickness (CCT) 88.6%, visual field 78.9%, gonioscopy 47.5%, and target intraocular pressure (IOP) 15.6%. 32.8% of patients were seen once while the remaining 67.2% had multiple visits. In patients with multiple visits, providers were more likely to document systemic history (100.0% vs. 97.5%, P=0.0346), review of systems (100.0% v. 97.5%, P=0.0346), gonioscopy (60.0% v. 22.0%, P<0.001), CCT (94.2% v. 77.1%, P<0.001), visual field (97.5% v. 40.7%, P<0.001), and target IOP (22.4% v. 1.7%, P<0.001) compared to single visit patients. In stratifying results by diagnosis, POAG patients more often received visual field testing (92.7% v. 68.9%, P<0.001) and had an established target IOP (35.1% v. 1.4%, P<0.001) compared to POAGS patients.
CONCLUSIONS: Compliance with PPP guidelines for glaucoma care was very high for most elements but lower for performing DFE, CCT, visual field, gonioscopy, and target IOP. This study highlights deficiencies in care likely to hamper the detection of glaucoma progression.

PMID: 30234750 [PubMed - as supplied by publisher]