Minimising the implementation gap in management of narrow angle glaucoma suspects through education and technology  

Lead investigator: Paddy Gunn

Host institution: Manchester Royal Eye Hospital

The prevalence of glaucoma is increasing and so too is the demand for capacity within glaucoma services¹. The Royal College of Ophthalmologists² and College of Optometrists³ recently released new guidance on when to refer and treat patients at risk of narrow angle glaucoma. The guidance recommends a higher threshold of risk for both referral and treatment than what has been used before.

The aims of these changes are:

• to provide clarity on who should be referred and treated;

• reduce unnecessary referrals to the hospital eye service, creating more capacity for higher risk patients;

• reducing unnecessary treatment for patients at lower risk of developing narrow angle closure glaucoma.

The challenge of bridging the gap between published guidance and the reality of clinicians having the knowledge and skills to fully implement them has been well described4. Given the potentially sight threatening nature of an acute episode of angle closure glaucoma, eye health professionals have taken a cautious approach to referral and treatment. Sheth et al. published a national survey in 20055 demonstrating a high uptake of prophylactic treatment for patients at risk of acute glaucoma and this guidance represents a notable shift in recommended practice.

To maximise the benefit of this new guidance, this requires clinicians to have the knowledge and confidence to implement them in their clinical practice. We will evaluate optometrists’ understanding and implementation of the guidance by surveying optometrists before and after educational interventions. In addition, we will work with a provider of an electronic referral platform to develop a prompt-based system to support referring optometrists to encourage adherence to the guidance. We will measure adherence to referrals guidance recommendations at intervals throughout the study, to measure the impact of our interventions and to inform those responsible for glaucoma patient pathways on minimising guidance implementation gaps.

References

1. 1. Royal College of Ophthalmologists. The Way Forward – Glaucoma. 2017. https://www.rcophth.ac.uk/wp-content/uploads/2022/06/Management-of-Open-Angle-Closure-Glaucoma-1.pdf

2. Royal College of Ophthalmologists. Management of Angle-Closure Glaucoma. 2022. https://www.rcophth.ac.uk/wp-content/uploads/2022/06/Management-of-Open-Angle-Closure-Glaucoma-1.pdf.

3. College of Optometrists. 2022. Primary Angle Closure/Primary Angle Closure Glaucoma. 2022. https://www.college-optometrists.org/clinical-guidance/clinical-management-guidelines/primaryangleclosure_primaryangleclosureglaucoma_pa

4. Shiffman RN, Michel G, Essaihi A, Thornquist E. Bridging the guideline implementation gap: a systematic, document-centered approach to guideline implementation. J Am Med Inform Assoc. 2004 Sep-Oct;11(5):418-26. doi: 10.1197/jamia.M1444. Epub 2004 Jun 7. PMID: 15187061; PMCID: PMC516249.

5. Sheth HG, Goel R, Jain S. UK national survey of prophylactic YAG iridotomy. Eye (Lond). 2005 Sep;19(9):981-4. doi: 10.1038/sj.eye.6701696. PMID: 15375356.