|Institution:||University of New South Wales|
|Department:||Optometry & Vision Science|
|Keywords:||Glaucoma; Delivery; Referral; Pathway|
|Full text PDF:||http://handle.unsw.edu.au/1959.4/54387|
Australian eye health care is under substantial pressure partially due to increasing patient loads and the growing number of elderly people with age-related eye disease. Patients failing to access appropriate ophthalmic care may develop irreversible vision loss due to undetected eye disease and/or insufficient management. Evidence-based recommendations highlighted the importance of establishing appropriate referral pathways under collaborative approach to facilitate easy access to ophthalmic care and enhance early detection and management of eye disease. In this thesis, an examination of the current Australian referral patterns concerning patients with age-related macular degeneration, diabetic retinopathy or glaucoma revealed a heavy burden placed upon ophthalmologists and the late involvement of allied services. This suggested the need for a better liaison between general practitioners and optometrists to alleviate the patient load on ophthalmology, enhance early detection, and improve outcomes. To address the potential for optometrists to take a more proactive role in eye care delivery, the aptitude of optometrists to utilise techniques for the diagnosis and management of glaucoma patients was evaluated in concordance with the relevant guidelines. Techniques comprising gonioscopy, pachymetry, pupil dilation for ONH/RNFL examination, and documentation of findings via permanent records were not assimilated well into optometric practice. Regression models highlighted that the optometrists’ educational background was critical to maintaining satisfactory competency standards with these screening techniques. The lack of penetration and application of advanced imaging techniques could be circumvented through specialised diagnostic and imaging centres as part of alternative care approaches that may need to be implemented to maximise efficient patient care. To test this, the patient database of a new designated referral-only centre, providing practitioners with comprehensive glaucoma assessments, was mined. This confirmed over 90% true positive referrals and as few as 7.8% false positives by optometrists for glaucoma patients if appropriate assistance with advanced imaging was provided. The main factors compromising sound clinical care following glaucoma diagnosis using this method was the adjustment of diagnostic decisions based upon patient age and a poor level of continuity of care. The proposed model showed potential to assist in the allocation of resources effectively and improve patient care.