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NICE – impact on glaucoma case detection

Shah, S; Murdoch, IE; (2011) NICE – impact on glaucoma case detection. Ophthalmic and Physiological Optics , 31 (4) pp. 339-342. 10.1111/j.1475-1313.2011.00843.x. Green open access

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Abstract

Aim:  To investigate the impact of publication of the National Institute of Clinical Excellence (NICE) guidelines (‘Glaucoma: diagnosis and management of chronic open angle glaucoma and ocular hypertension’) in April 2009, on the referrals for suspect glaucoma to Moorfields Community Eye Clinic (MCEC) at Ealing Hospital. / Methods:  The clinical data from all optometrist initiated referrals for suspect glaucoma and ocular hypertension were scrutinised by a Consultant Ophthalmologist for a 2 month period, 6 months after the publication of the NICE guidance. Each was then categorised into the following groups: glaucoma positive; glaucoma suspect; glaucoma negative; ocular hypertension (OHT) requiring further follow up in clinic; ocular hypertension to be followed up by community optometrist; other. The positive predictive value (PPV) was then calculated and a historical comparison made with previous studies. / Results:  A total of 110 new referrals were assessed during the collection period, which reflects a marked increase in numbers attending. However, there was no increase in absolute numbers of glaucoma and glaucoma suspects identified. The absolute numbers of ocular hypertensive patients rose. The PPV fell to 0.25, which is lower than found in previous studies. / Conclusions:  The rising number of new referrals and the unchanged absolute numbers of glaucoma and glaucoma suspects identified following publication of the NICE guidance, in addition to a lower PPV, makes us question what advantage in improved case detection this represents. Furthermore, is this a cost effective strategy? We believe the next step is to introduce a repeat review, with carefully considered clinical governance of any new scheme.

Type: Article
Title: NICE – impact on glaucoma case detection
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/j.1475-1313.2011.00843.x
Publisher version: http://dx.doi.org/10.1111/j.1475-1313.2011.00843.x
Language: English
Additional information: This is the peer reviewed version of the following article: Shah, S; Murdoch, IE; (2011) NICE – impact on glaucoma case detection. Ophthalmic and Physiological Optics, 31 (4) pp. 339-342, which has been published in final form at: http://dx.doi.org/10.1111/j.1475-1313.2011.00843.x. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Institute of Ophthalmology
URI: https://discovery.ucl.ac.uk/id/eprint/1513287
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