Orthoptist-Led Glaucoma Monitoring: A Pilot Quality Assurance Audit of the Reliability of Orthoptists in Glaucoma Management Decisions
Background: This study aimed to evaluate the safety of an orthoptist-led glaucoma monitoring clinic in a tertiary hospital in Victoria, Australia, by reviewing the agreement between orthoptists and an experienced ophthalmologist in the clinical management decision.
Methods: A random sample of patient encounters which occurred during an 11-month period in an orthoptist-led Glaucoma Monitoring Clinic (GMC) at a tertiary hospital were randomly selected. Electronic medical records were deidentified and retrospectively reviewed by a senior consultant ophthalmologist with the clinical decision and review removed. Agreement between the clinical management decisions made by two orthoptists with a special interest in glaucoma and the ophthalmologist were analysed.
Results: When comparing agreement between the orthoptists and the ophthalmologist, agreement was noted for 18 of the 21 (85.71%) patient encounters. A kappa analysis showed substantial agreement for the clinical management decisions of patients diagnosed with a glaucoma (κ = 0.690; 95% CI 0.369 – 1.011). In addition, agreement was strong for the timing of the follow-up review with 13 of the 18 (72.2%) encounters in agreement (κ = 0.639; 95% CI 0.388 – 0.890).Conclusion: Substantial agreement was found between orthoptists and an ophthalmologist in the management of patients who were suspected of glaucoma or diagnosed with stable primary open angle glaucoma or ocular hypertension. This suggests that there may be a role for trained orthoptists in the screening and monitoring of glaucoma patients.