Cambridge community Optometry Glaucoma Scheme

Background: With a higher life expectancy, there is an increased demand for hospital glaucoma services in the United Kingdom. Design: The Cambridge community Optometry Glaucoma Scheme (COGS) was initiated in 2010, where new referrals for suspected glaucoma are evaluated by community optometrists with a special interest in glaucoma, with virtual electronic review and validation by a consultant ophthalmologist with special interest in glaucoma. Participants: 1733 patients were evaluated by this scheme between 2010 and 2013. Methods: Clinical assessment is performed by the optometrist at a remote site. Goldmann applanation tonometry, pachymetry, monoscopic colour optic disc photographs and automated Humphrey visual field testing are performed. A clinical decision is made as to whether a patient has glaucoma or is a suspect, and referred on or discharged as a false positive referral. The clinical findings, optic disc photographs and visual field test results are transmitted electronically for virtual review by a consultant ophthalmologist. Main Outcome Measures: The number of false positive referrals from initial referral into the scheme. Results: Of the patients, 46.6% were discharged at assessment and a further 5.7% were discharged following virtual review. Of the patients initially discharged, 2.8% were recalled following virtual review. Following assessment at the hospital, a further 10.5% were discharged after a single visit. Conclusions: The COGS community‐based glaucoma screening programme is a safe and effective way of evaluating glaucoma referrals in the community and reducing false‐positive referrals for glaucoma into the hospital system.