Effectiveness of Elevated Intraocular Pressure as a Criterion for Glaucoma Referral After 6 Years of Follow-Up

Andreas G Nilsson,1 Dorothea Peters2 1Department of Ophthalmology, Skåne University Hospital, Malmö, Sweden; 2Department of Clinical Sciences Malmö, Ophthalmology, Lund University, Malmö, SwedenCorrespondence: Andreas G Nilsson Email andreas.g.nilsson@skane.sePurpose: To evaluate the long-term predi...

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Autores principales:	Nilsson AG, Peters D
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2021
Materias:	optometric practices long-term guidelines ophthalmology sweden Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/95907b5c90754bee913eeeb04e4cade2
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spelling	oai:doaj.org-article:95907b5c90754bee913eeeb04e4cade22021-12-02T15:32:48ZEffectiveness of Elevated Intraocular Pressure as a Criterion for Glaucoma Referral After 6 Years of Follow-Up1177-5483https://doaj.org/article/95907b5c90754bee913eeeb04e4cade22021-07-01T00:00:00Zhttps://www.dovepress.com/effectiveness-of-elevated-intraocular-pressure-as-a-criterion-for-glau-peer-reviewed-fulltext-article-OPTHhttps://doaj.org/toc/1177-5483Andreas G Nilsson,1 Dorothea Peters2 1Department of Ophthalmology, Skåne University Hospital, Malmö, Sweden; 2Department of Clinical Sciences Malmö, Ophthalmology, Lund University, Malmö, SwedenCorrespondence: Andreas G Nilsson Email andreas.g.nilsson@skane.sePurpose: To evaluate the long-term predictive value of the need to treat patients referred by optometric practitioners, regarding glaucoma, in Malmö, Sweden, using intraocular pressure (IOP) as the primary referral criterion.Patients and Methods: This retrospective study included 94 of 108 (87%) individuals referred to the Skåne University Hospital in Malmö, Sweden, for elevated IOP during 2012– 2013. Data were extracted from patient records by the end of 2019. Positive outcome was defined as glaucoma, treated suspected glaucoma or treated ocular hypertension (OH) at referral or during the follow-up period. Positive predictive values (PPV) were calculated using different hypothetical thresholds for age and IOP-levels. Long-term follow-up was used to evaluate whether the first visit diagnoses would change over time, and if this would affect the effectiveness of the referrals.Results: Elevated IOP was the only referral criterion in 84% (n=79). In 28 patients (35%) among the IOP-only referrals, no ocular disease was found, and 26 patients (33%) had a positive outcome at the first visit. Median follow-up time was 6.4 years. PPV according to diagnosis after follow-up was 42% (95% CI: 32– 54%) for IOP-only referrals. Including thresholds of ≥ 45 years of age in combination with an IOP of ≥ 25 mmHg in the referral criteria would have reduced the number of IOP-only referrals by 27% (21 of 79), and increased the PPV to 57% (95% CI: 45– 71%) at the last visit. No positive outcome would have been missed, among those that were followed-up after the first visit, when applying these thresholds for referral, over a follow-up period of six years.Conclusion: Using only elevated IOP as referral criterion showed a poor accuracy for predicting those that require IOP lowering treatment. The long-term follow-up allowed us to verify the applicability of higher hypothetical threshold requirements on age and IOP for glaucoma referrals from optometric practices.Keywords: optometric practices, long-term, guidelines, ophthalmology, SwedenNilsson AGPeters DDove Medical Pressarticleoptometric practiceslong-termguidelinesophthalmologyswedenOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 15, Pp 3041-3049 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	optometric practices long-term guidelines ophthalmology sweden Ophthalmology RE1-994
spellingShingle	optometric practices long-term guidelines ophthalmology sweden Ophthalmology RE1-994 Nilsson AG Peters D Effectiveness of Elevated Intraocular Pressure as a Criterion for Glaucoma Referral After 6 Years of Follow-Up
description	Andreas G Nilsson,1 Dorothea Peters2 1Department of Ophthalmology, Skåne University Hospital, Malmö, Sweden; 2Department of Clinical Sciences Malmö, Ophthalmology, Lund University, Malmö, SwedenCorrespondence: Andreas G Nilsson Email andreas.g.nilsson@skane.sePurpose: To evaluate the long-term predictive value of the need to treat patients referred by optometric practitioners, regarding glaucoma, in Malmö, Sweden, using intraocular pressure (IOP) as the primary referral criterion.Patients and Methods: This retrospective study included 94 of 108 (87%) individuals referred to the Skåne University Hospital in Malmö, Sweden, for elevated IOP during 2012– 2013. Data were extracted from patient records by the end of 2019. Positive outcome was defined as glaucoma, treated suspected glaucoma or treated ocular hypertension (OH) at referral or during the follow-up period. Positive predictive values (PPV) were calculated using different hypothetical thresholds for age and IOP-levels. Long-term follow-up was used to evaluate whether the first visit diagnoses would change over time, and if this would affect the effectiveness of the referrals.Results: Elevated IOP was the only referral criterion in 84% (n=79). In 28 patients (35%) among the IOP-only referrals, no ocular disease was found, and 26 patients (33%) had a positive outcome at the first visit. Median follow-up time was 6.4 years. PPV according to diagnosis after follow-up was 42% (95% CI: 32– 54%) for IOP-only referrals. Including thresholds of ≥ 45 years of age in combination with an IOP of ≥ 25 mmHg in the referral criteria would have reduced the number of IOP-only referrals by 27% (21 of 79), and increased the PPV to 57% (95% CI: 45– 71%) at the last visit. No positive outcome would have been missed, among those that were followed-up after the first visit, when applying these thresholds for referral, over a follow-up period of six years.Conclusion: Using only elevated IOP as referral criterion showed a poor accuracy for predicting those that require IOP lowering treatment. The long-term follow-up allowed us to verify the applicability of higher hypothetical threshold requirements on age and IOP for glaucoma referrals from optometric practices.Keywords: optometric practices, long-term, guidelines, ophthalmology, Sweden
format	article
author	Nilsson AG Peters D
author_facet	Nilsson AG Peters D
author_sort	Nilsson AG
title	Effectiveness of Elevated Intraocular Pressure as a Criterion for Glaucoma Referral After 6 Years of Follow-Up
title_short	Effectiveness of Elevated Intraocular Pressure as a Criterion for Glaucoma Referral After 6 Years of Follow-Up
title_full	Effectiveness of Elevated Intraocular Pressure as a Criterion for Glaucoma Referral After 6 Years of Follow-Up
title_fullStr	Effectiveness of Elevated Intraocular Pressure as a Criterion for Glaucoma Referral After 6 Years of Follow-Up
title_full_unstemmed	Effectiveness of Elevated Intraocular Pressure as a Criterion for Glaucoma Referral After 6 Years of Follow-Up
title_sort	effectiveness of elevated intraocular pressure as a criterion for glaucoma referral after 6 years of follow-up
publisher	Dove Medical Press
publishDate	2021
url	https://doaj.org/article/95907b5c90754bee913eeeb04e4cade2
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Effectiveness of Elevated Intraocular Pressure as a Criterion for Glaucoma Referral After 6 Years of Follow-Up

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