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   Table of Contents      
COMMENTARY
Year : 2020  |  Volume : 68  |  Issue : 3  |  Page : 474-475

Commentary: Assessment of glaucoma referral letter for quality and accuracy among patients referred to a tertiary eye care centre


Glaucoma Services, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Date of Web Publication14-Feb-2020

Correspondence Address:
Prof. Sushmita Kaushik
Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh - 160 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_2310_19

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How to cite this article:
Kaushik S. Commentary: Assessment of glaucoma referral letter for quality and accuracy among patients referred to a tertiary eye care centre. Indian J Ophthalmol 2020;68:474-5

How to cite this URL:
Kaushik S. Commentary: Assessment of glaucoma referral letter for quality and accuracy among patients referred to a tertiary eye care centre. Indian J Ophthalmol [serial online] 2020 [cited 2020 May 27];68:474-5. Available from: http://www.ijo.in/text.asp?2020/68/3/474/278357



In this paper, the authors have addressed an interesting and often neglected area in disease management—a good referral letter.[1] Glaucoma is estimated to affect 12 million Indians and causes 5.8% of the blindness in the country.[2] In a population-based survey, the Chennai Glaucoma Study revealed that 94.1% of glaucoma was undiagnosed.[3] Unless we improve the detection rates significantly, the associated morbidity and blindness due to glaucoma would be very difficult to be curtailed. In the absence of any one parameter to diagnose the disease, opportunistic screening of ophthalmic patients appears to be the best way to detect cases early. There is an urgent need to adopt comprehensive eye examinations, including intraocular pressure (IOP) measurement, gonioscopy, and optic disc evaluation, as a routine.

Given the paucity of glaucoma specialists in India, comprehensive ophthalmologists diagnose and treat most glaucoma. A recent poll[4] about prevalent practice patterns among glaucoma specialists and general ophthalmologists revealed a significant disparity between both groups with regard to IOP measurement, the practice of gonioscopy, and disc evaluation in clinical evaluation. Referrals to tertiary centers are usually done in the scenarios of “doubt” of glaucoma or uncontrolled, progressive glaucoma generally requiring surgery. In this context, a good referral letter to a tertiary care center should ideally provide valuable clinical information and indicate the degree of urgency to ensure timely management. One survey revealed that glaucoma specialists found maximum IOP, recent IOP, serial visual fields (VFs), disc evaluation, and serial disc imaging as the most helpful information for both diagnosis and progression of glaucoma.[5]

This paper provides details of significant findings. Gonioscopy was not performed in 94% of cases. Of the 102 patients referred to as glaucoma suspects, 54% were found to have primary angle closure disease (PACD). Given that primary angle-closure glaucoma (PACG) is more blinding than primary open-angle glaucoma (POAG), and that laser iridotomy is an effective modality in the early stages of the disease, it is worrisome that referrals are sent without gonioscopy.

The proposed referral letter template is a useful idea which, if adopted, would not only save precious time and resources to an already overburdened tertiary care system in India but would also help inculcate the practice of comprehensive examination of the patient before referring. This may even translate into the positive effect of resulting in definitive diagnosis and appropriate management at the place of examination avoiding many referrals altogether.



 
  References Top

1.
Venkataraman P, Chandran P, Faheem M, Arunaachalam V, Aboobacker N, Raman GV. Assessment of glaucoma referral letter for quality and accuracy among patients referred to a tertiary eye care center. Indian J Ophthalmol 2020;68:471-4.  Back to cited text no. 1
  [Full text]  
2.
Thomas R, Paul P, Rao GN, Muliyil JP, Mathai A. Present status of eye care in India. Surv Ophthalmol 2005;50:85-101.  Back to cited text no. 2
    
3.
Vijaya L, George R, Baskaran M, Arvind H, Raju P, Ramesh SV, et al. Prevalence of primary open-angle glaucoma in an urban south Indian population and comparison with a rural population. The Chennai Glaucoma Study. Ophthalmology 2008;115:648-54.  Back to cited text no. 3
    
4.
Choudhari NS, Pathak-Ray V, Kaushik S, Vyas P, George R. Prevalent practice patterns in glaucoma: Poll of Indian ophthalmologists at a national conference. Indian J Ophthlamol 2016;64:715-21.  Back to cited text no. 4
    
5.
Cheng J, Beltran-Agullo L, Trope GE, Buys YM. Assessment of the quality of glaucoma referral letters based on a survey of glaucoma specialists and a glaucoma guideline. Ophthalmology 2014;121:126-33.  Back to cited text no. 5
    




 

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