The false negative rate and the role for virtual review in a nationally evaluated glaucoma referral refinement scheme.
PURPOSE
To establish the safety of the CHANGES glaucoma referral refinement scheme (GRRS).


METHODS
The CHANGES scheme risk stratifies glaucoma referrals, with low risk referrals seen by a community based specialist optometrist (OSI) while high risk referrals are referred directly to the hospital. In this study, those patients discharged by the OSI were reviewed by the consultant ophthalmologist to establish a 'false negative' rate (Study 1). Virtual review of optic disc photographs was carried out both by a hospital-based specialist optometrist as well as the consultant ophthalmologist (Study 2).


RESULTS
None of these 34 discharged patients seen by the consultant were found to have glaucoma or started on treatment to lower the intra-ocular pressure. Five of the 34 (15%) were classified as 'glaucoma suspect' based on the appearance of the optic disc and offered a follow-up appointment. Virtual review by both the consultant and optometrist had a sensitivity of 80%, whilst the false positive rate for the optometrist was 3.4%, and 32% for the consultant (p < 0.05).


CONCLUSIONS
The false negative rate of the OSIs in the CHANGES scheme was 15%, however there were no patients where glaucoma was missed. Virtual review in experienced hands can be as effective as clinical review by a consultant, and is a valid method to ensure glaucoma is not missed in GRRS. The CHANGES scheme, which includes virtual review, is effective at reducing referrals to the hospital whilst not compromising patient safety.
['Ratnarajan|Gokulan|G|', 'Kean|Jane|J|', 'French|Karen|K|', 'Parker|Mike|M|', 'Bourne|Rupert|R|']
D000328:Adult D000368:Aged D005188:False Negative Reactions D005260:Female D005901:Glaucoma D006801:Humans D007429:Intraocular Pressure D008297:Male D008875:Middle Aged D009798:Ocular Hypertension D009907:Optometry D012017:Referral and Consultation D014065:Tonometry, Ocular D006113:United Kingdom D015351:Vision Screening D058609:Visual Field Tests D014794:Visual Fields
false negative rate virtual review glaucoma referral refinement optometrists with specialist interest in glaucoma