An Australian and US study has found that, compared to in-depth annual reviews, less stringent six-monthly reviews of glaucoma suspects resulted in more diagnoses, fewer overall clinical visits and reduced cost per diagnosis.
Led by the University of New South Wales (UNSW) Sydney’s Dr Jack Phu and Professor Michael Kalloniatis, the study of 862 patients defined a glaucoma suspect as having any of the following characteristics: a first-degree family history of glaucoma, systemic disease (diabetes, hypertension, hypotension, migraines, or obstructive sleep apnea), or chronic corticosteroid use; elevated intraocular pressure (>21 mmHg); and/or suspicious optic nerve head appearance, including increased cup-to-disc ratio and asymmetric cup-to-disc ratio between eyes not explained by optic disc size, thin neuroretinal rim, disc haemorrhage, and/or retinal nerve fiber layer defect but without the corresponding visual field loss that is characteristic of glaucoma. Researchers defined ‘stringent’ reviews as requiring a minimum of three of these risk factors.
Further, researchers demonstrated that Australian optometrists conducting the reviews cost around AU$400 per diagnosis, compared with ophthalmologists at $600, if only Australian Medicare was charged.
“The stringency of risk assessments for glaucoma suspects impacts review periods and therefore clinical load, healthcare costs, and diagnosis rates. Using current testing methods, more frequent review periods appear advantageous for diagnostic effciency, with both lower clinic load and lower cost up until the point of discharge or glaucoma diagnosis,” researchers concluded.
