Document Type

Theses, Ph.D

Rights

This item is available under a Creative Commons License for non-commercial use only

Publication Details

Thesis submitted for the award of Doctor of Philosophy to Dublin Institute of Technology, 2017.

Abstract

Optometrists play a vital role in the detection of glaucoma, a leading cause of irreversible blindness. As population screening for glaucoma is neither cost effective nor viable, glaucoma is primarily detected through opportunistic case-finding during routine eye examinations. The present study provides new insight into optometrists’ practice patterns for glaucoma detection in Ireland. Chapters 3 and 4 report on a national survey. The results show that optometrists are well equipped to carry out the traditional glaucoma case finding triad. However, moving towards enhanced services such as monitoring glaucoma suspects or ocular hypertension cases would require some investment in equipment and training. Training, finance, and time restrictions were identified by optometrists as key barriers to detecting glaucoma during routine eye examinations. Optometrists showed strong interest in furthering optometric professional development and expanding the traditional role boundaries in Ireland. Chapters 5 and 6 describe our pilot collaborative care pathway, the Dublin glaucoma referral refinement and monitoring service. This pathway facilitated community refinement and monitoring of the majority (62%) of glaucoma suspect patients (n = 225) referred by optometrists, acting to bridge the gap between the sensitivity required when case finding for glaucoma and the specificity required when initiating treatment. Chapter 7 presents an analysis of optometrists’ referral letters for suspect glaucoma, establishing an objective reference point for optometric case-finding strategies. The results highlight key areas for clinical practice reforms such as uptake of Goldmann applanation tonometry, pachymetry, and disc size measurement. Chapter 8 provides a summary and conclusions on the work, and contains recommendations for future research.

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