Recommendation ID

Referral filtering:- What is the effectiveness and cost effectiveness of the different models for glaucoma filtering (pathways from case-finding to assessment in secondary ophthalmic care) for detecting glaucoma and glaucoma-related conditions (ocular hypertension and suspected glaucoma)?

Any explanatory notes
(if applicable)

Why this is important:- Routine optometric sight testing has poor sensitivity and specificity for detecting glaucoma and glaucoma-related conditions, resulting in a high percentage of false positive referrals to secondary care. These are costly for commissioners, cause unnecessary anxiety for patients and are a burden for secondary care. A variety of referral filtering models have been developed to improve the accuracy of referrals. These include 'repeat measures' schemes in which IOP measurement or
visual field assessments, or both, are repeated at a separate visit; 'enhanced case-finding' referral enhancement schemes in which IOP measurements are repeated, detailed disc assessment is carried out and visual fields are performed with automated perimetry; 'referral refinement' schemes, which require tests sufficient for the diagnosis of ocular hypertension and suspected COAG, including gonioscopy, and the interpretation of these clinical findings.
Each scheme requires different levels of healthcare training and qualifications. Investment in equipment may also be needed to set up these services, and professionals would expect remuneration for providing these models of care.
It is unclear which of these models is the most accurate (sensitive and specific) and which is most cost effective. Evidence is therefore needed so that commissioners can commission the best services that allow accurate referral to secondary care for glaucoma assessment.

Source guidance details

Comes from guidance
Glaucoma: diagnosis and management
Date issued
November 2017

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 30/11/2017