Optometrists’ Adherence to AAO Glaucoma Guidelines

■ How well do retail optometrists follow the American Academy of Ophthalmology (AAO) preferred practice pattern guidelines (PPP) for diagnosing and identifying progression of primary open-angle glaucoma (POAG)? Researchers at the University of Alabama Birmingham Department of Ophthalmology sought to determine the level of adherence to the AAO guidelines for quality POAG and POAG-suspect (POAGS) care among retail-based optometrists.

Patients with a diagnosis of POAG or POAGS who participated in a telemedicine pilot project were included. Patients’ charts were evaluated for 15 elements of PPP guidelines for glaucoma care. Results were further stratified by number of follow-up visits and diagnosis.

Of 360 identified patients, 10 elements were documented in over 98%. Documentation of the remaining 5 components was as follows: dilated fundus exam (DFE) 91.1%, central corneal thickness (CCT) 88.6%, visual field 78.9%, gonioscopy 47.5%, and target IOP 15.6%. Overall, 32.8% of patients were seen once while the remaining 67.2% had multiple visits. In patients with multiple visits, providers were more likely to document systemic history, review of systems, gonioscopy, CCT, visual field, and target IOP compared to single-visit patients. In stratifying results by diagnosis, POAG patients more often received visual field testing and had an established target IOP compared to POAGS patients.

The researchers concluded that compliance with PPP guidelines for glaucoma care was very high for most elements but lower for performing DFE, CCT, visual field, gonioscopy, and target IOP. This study highlights deficiencies in care likely to hamper the detection of glaucoma progression.