The Bristol shared care glaucoma study: outcome at follow up at 2 years

Aim-To examine the outcome of care for patients with glaucoma followed up b y the hospital eye service compared with those followed up by community opt ometrists. Methods-A randomised study with patients allocated to follow up by the hosp ital eye service or community optometrists was carried out in the former co unty of Avon in south west England. 403 patients with established or suspec ted primary open angle glaucoma attending Bristol Eye Hospital and meeting defined inclusion and exclusion criteria were studied. The mean number of m issed points on visual field testing in the better eye (using a "better/wor se" eye analysis) in each group were measured. The visual field was measure d using the Henson semiautomated central field analyser (CFA 3000). Measure ments were made by the research team on all patients at baseline before ran domisation and again 2 years after randomisation. The mean number of missed points on visual field testing in the worse eye, mean intraocular pressure (mm Hg), and cup disc ratio using a "better/worse" eye analysis in each gr oup at 2 years were also measured. Measurements were made by the research t eam on all patients at baseline before randomisation and again 2 years afte r randomisation. An analysis of covariance comparing method of follow up ta king into account baseline measurements of outcome variables was carried ou t. Additional control was considered for age, sex, diagnostic group (glauco ma suspect/established primary open angle glaucoma), and treatment (any/non e). Results-From examination of patient notes, 2780 patients with established o r suspected glaucoma were identified. Of these, 752 (27.1%) fulfilled the e ntry criteria. For hospital and community follow up group respectively, mea n number of missed points on visual field testing at 2 year follow up for b etter eye was 7.9 points and 6.8 points; for the worse eye 20.2 points and 18.4 points. Similarly, intraocular pressure was 19.3 mm Hg and 19.3 mm Hg (better eye), and 19.1 mm Hg and 19.0 mm Hg (worse eye); cup disc ratio at 2 year follow up was 0.72 and 0.72 (better eye), and 0.73 and 0.74 for hosp ital and community follow up group respectively. No significant differences in any of the key visual variables were found between the two groups befor e or after adjusting for baseline values and age, sex, treatment, and type of glaucoma. Conclusions-It is feasible to set and run shared care schemes for a proport ion of patients with suspected and established glaucoma using community opt ometrists. After 2 years (a relatively short time in the life of a patient with glaucoma), there were no marked or statistically significant differenc es in outcome between patients followed up in the hospital eye service or b y community optometrists. Decisions to implement such schemes need to be ba sed on careful consideration of the costs of such schemes and local circums tances, including geographical access and the current organisation of glauc oma care within the hospital eye service.