A tool, widely regarded as the "gold standard," but often deemed to be too expensive, cuts needless referrals for suspected glaucoma, indicates preliminary research published online in the British Journal of
Since the publication of new guidance from the National
Institute for Health and Clinical Excellence (NICE), new referrals for
suspected glaucoma have increased substantially. And this is likely to go on
rising as the population ages, warn the authors. If left untreated, glaucoma
This sharp rise in referrals is putting a strain on hospital
eye services, bumping up costs, and causing unnecessary distress for patients,
say the authors.
But not all of these people would need to be referred if a
more selective, but inevitably more expensive, piece of kit were used to test
The researchers assessed how many referrals for suspected
glaucoma - internal (intraocular) fluid eye pressure of over 21 - could be
avoided if the Goldmann applanation tonometer (GAT) were used for all patients.
High intraocular pressure is a key sign of glaucoma, and is
measured by the amount of pressure needed to flatten the surface of the eye
NICE recommends GAT, but other options are frequently used
instead by community optometrists, because they are cheaper and don't require
the use of anaesthetic eye drops.
Over a period of five months, people with intraocular
pressures of between 22 and 25, measured with other tonometers, and with no
other symptoms of glaucoma, were assessed again using GAT.
Out of 3,295 people assessed at four community optometry
services during this time, 73 (2.2%) had a high intraocular pressure. They
would normally have been referred to the hospital eye service for further
But when the assessment was repeated using GAT, almost two
thirds of this group (46) had intraocular pressures of 21 or below and so did
not need to be referred.
"The use of Goldmann applantion tonometry by
optometrists, prior to instigating a referral to the [hospital eye service] has
huge potential to reduce unnecessary referrals," conclude the authors.