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Australian and New Zealand optometrists are overall well-equipped to perform glaucoma assessments, with a large survey indicating a solid basis for glaucoma detection and management.

A self-reported online questionnaire of 574 Australian optometrists and 244 New Zealand optometrists revealed that examination techniques to detect glaucomatous change were available and confidently performed by practising optometrists, with the possible exception of gonioscopy.

The survey included a slightly greater proportion of optometrists who were therapeutically endorsed compared to the general optometric population with 45 per cent of Australian respondents and 61 per cent of New Zealand respondents being therapeutically endorsed.

The survey aimed to evaluate access to, confidence with and application of tests required for a comprehensive glaucoma assessment complying with 2010 NHMRC glaucoma guidelines.

Overall, 55 per cent of Australian respondents were moderately to extremely familiar with the NHMRC glaucoma guidelines.

Confident

Essential and preferred clinical equipment for assessment was available in both countries and most practitioners were confident or very confident with clinical procedures essential for glaucoma assessment.

Therapeutically endorsed optometrists in the survey performed better overall and were much more likely to have access to and more confidence in performing gonioscopy.

Therapeutic endorsement, knowledge of glaucoma guidelines and number of glaucoma training courses attended in recent years were main variables to increase confidence. In the past three years, 63 per cent of Australian practitioners had attended glaucoma-specific training.

Optometrists indicated confidence in visual field testing, with most using gold standard white on white standard automated perimetry and only 1.3 per cent of Australian optometrists not including this as part of a glaucoma assessment.

All optometrists surveyed were equipped to provide optic nerve head (ONH) assessments by direct ophthalmoscopy or slitlamp fundoscopy and most had the opportunity to permanently record results by ONH/retinal nerve fibre layer photography.

One-third of Australian respondents were not confident with pachymetry but despite this there were high levels of access to and confidence with all other techniques used in glaucoma assessment.

The survey also looked at advanced imaging modalities such as OCT, ONH photography, GDx and HRT and their integration into practice.

One in four respondents reported having an OCT in their practice while one in two overall reported a colleague nearby with an OCT that could be accessed.

Of the advanced imaging technologies only GDx and HRT were not yet easily accessible in the optometry setting.

Younger practitioners in the survey reported greater confidence in slitlamp fundoscopy whereas practitioners with more years of experience reported more confidence with direct ophthalmoscopy.

Researchers said glaucoma assessments would benefit from improved skill levels of gonioscopy and pachymetry, and education with advanced training opportunities including practical components to foster confident and safe application of techniques.

The glaucoma assessment survey was conducted by the Centre for Eye Health at the University of New South Wales with the help of Optometry Australia and the New Zealand Association of Optometrists in late 2012 and early 2013.

First results were published in the September 2014 issue of Ophthalmic and Physiological Optics.

 

Jamous KF, Kalloniatis M, Hayen A, Mitchell P, Stapleton FJ, and Zangerl B. Application of clinical techniques relevant for glaucoma assessment by optometrists: concordance with guidelines. Ophthalmic and Physiological Optics (doi: 10.1111/opo.12146 September 2014 issue.)

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