A survey of attitudes of glaucoma subspecialists in England and Wales to visual field test intervals in relation to NICE guidelines

Abstract

Objectives: To establish the attitudes of glaucoma specialists to the frequency of visual field (VF) testing in the UK, using the NICE recommendations as a standard for ideal practice.

Design: Interview and postal survey.

Setting: UK and Eire Glaucoma Society national meeting 2011 in Manchester, UK, with a second round of surveys administered by post.

Participants: All consultant glaucoma specialists in England and Wales were invited to complete the survey.

Primary and secondary outcome measures: (1) Compliance of assigned follow-up VF intervals with NICE guidelines for three hypothetical patient scenarios, with satisfactory treated intraocular pressure and (a) no evidence of VF progression; (b) evidence of VF progression and (c) uncertainty about VF progression, and respondents were asked to provide typical follow-up intervals representative of their practice; (2) attitudes to research recommendations for six VF in the first 2 years for newly diagnosed patients with glaucoma.

Results: 70 glaucoma specialists completed the survey. For each of the clinical scenarios a, b and c, 14 (20%), 33 (47%) and 28 (40%) responses, respectively, fell outside the follow-up interval recommended by NICE. Nearly half of the specialists (46%) agreed that 6 VF tests in the first 2 years was ideal practice, while 16 (28%) said this was practice 'not possible', with many giving resources within the NHS setting as a limiting factor.

Conclusions: The results from this survey suggest that there is a large variation in attitudes to follow-up intervals for patients with glaucoma in the UK, with assigned intervals for VF testing which are, in many cases, inconsistent with the guidelines from NICE.

Keywords: NICE recommendations; Primary open angle glaucoma; Survey; Visual fields.

Figure 1

Responses from 70 Consultant Ophthalmologists with a declared subspecialist interest in glaucoma, giving minimum (lower error bars) and maximum (upper error bars) follow-up intervals for a hypothetical patient with intraocular pressure at ‘target’ and (A) no evidence of visual field progression and no change in treatment; (B) evidence of visual field progression and no change in treatment; (C) uncertainty about visual field progression and no change in treatment. Single bars represent values for which only a single interval was given by respondents, without specifying the minimum / maximum monitoring interval.

Figure 2

Summary of views of responders to the suggestion that six visual field tests should be performed in the first 2 years for a newly diagnosed patient with primary open-angle glaucoma.