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Compliance With Primary Open-angle Glaucoma and Primary Open-angle Glaucoma Suspect Preferred Practice Patterns in a Retail-based Eye Clinic

Stanley, Jordan, MD*; Huisingh, Carrie E., MPH*; Swain, Thomas A., MPH*; McGwin, Gerald Jr, MS, PhD*,†; Owsley, Cynthia, PhD, MSPH*; Girkin, Christopher A., MD, MSPH*; Rhodes, Lindsay A., MD*

doi: 10.1097/IJG.0000000000001093
Original Studies

Purpose: To determine the level of adherence to the American Academy of Ophthalmology preferred practice pattern (PPP) guidelines for quality primary open-angle glaucoma (POAG) and POAG suspect (POAGS) care among retail-based optometrists.

Methods: Patients with a diagnosis of POAG or POAGS who participated in a telemedicine pilot project were included. Patients’ charts were evaluated for 15 elements of PPP guidelines for glaucoma care. Results were further stratified by number of follow-up visits and diagnosis.

Results: Of 360 identified patients, 10 elements were documented in over 98%. Documentation of the remaining 5 components was as follows: dilated fundus examination 91.1%, central corneal thickness (CCT) 88.6%, visual field 78.9%, gonioscopy 47.5%, and target intraocular pressure (IOP) 15.6%. in total, 32.8% of patients were seen once, whereas the remaining 67.2% had multiple visits. In patients with multiple visits, providers were more likely to document systemic history (100.0% vs. 97.5%; P=0.0346), review of systems (100.0% vs. 97.5%; P=0.0346), gonioscopy (60.0% vs. 22.0%; P<0.001), CCT (94.2% vs. 77.1%; P<0.001), visual field (97.5% vs. 40.7%; P<0.001), and target IOP (22.4% vs. 1.7%; P<0.001) compared with single visit patients. In stratifying results by diagnosis, POAG patients more often received visual field testing (92.7% vs. 68.9%; P<0.001) and had an established target IOP (35.1% vs. 1.4%; P<0.001) compared with POAGS patients.

Conclusions: Compliance with PPP guidelines for glaucoma care was very high for most elements but lower for performing dilated fundus examination, CCT, visual field, gonioscopy, and target IOP. This study highlights deficiencies in care likely to hamper the detection of glaucoma progression.

*Department of Ophthalmology and Visual Sciences, School of Medicine

Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL

Supported by a cooperative agreement with the Centers for Disease Control and Prevention (#1U58DP004061) and a National Eye Institute grant (NIH/NEI 1K23EY025724-01A1), with supplemental support from the EyeSight Foundation of Alabama, Birmingham, AL, and Research to Prevent Blindness, New York, NY. The findings and conclusions in this paper are those of the authors and do not necessarily reflect the official position of the Centers for Disease Control and Prevention.

Disclosure: The authors declare no conflict of interest.

Reprints: Lindsay A. Rhodes, MD, Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, 1720 University Boulevard, Suite 601, Birmingham, AL 35233 (e-mail:

Received July 2, 2018

Accepted September 8, 2018

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