HNY Policy and Pathway Repository - Humber

No Definition/Description Listed

No Red Flag Symptoms Listed

Case-finding for Optometrists

The recommendations on case-finding are for primary eye care professionals before referral for diagnosis of chronic open angle glaucoma (COAG) and related conditions, and are separate from a sight test.

1. Before referral for further investigation and diagnosis of COAG and related conditions, offer all of the following tests:

• central visual field assessment using standard automated perimetry (full threshold or supra-threshold)
• optic nerve assessment and fundus examination using stereoscopic slit lamp biomicroscopy (with pupil dilatation if necessary), and optical coherence tomography (OCT) or optic nerve head image if available
• intraocular pressure (IOP) measurement using Goldmann-type applanation tonometry
• peripheral anterior chamber configuration and depth assessments using gonioscopy or, if not available or the patient prefers, the van Herick test or OCT. 

2. Do not base a decision to refer solely on IOP measurement using non-contact tonometry. 
3. Do not refer people who have previously been discharged from hospital eye services after assessment for COAG and related conditions unless clinical circumstances have changed and a new referral is needed. 
4. Before deciding to refer, consider repeating visual field assessment and IOP measurement on another occasion to confirm a visual field defect or IOP of 24 mmHg or more, unless clinical circumstances indicate urgent or emergency referral is needed. 
5. Refer for further investigation and diagnosis of COAG and related conditions, after considering repeat measures as in recommendation if:

• there is optic nerve head damage on stereoscopic slit lamp biomicroscopy or
• there is a visual field defect consistent with glaucoma or
• IOP is 24 mmHg or more using Goldmann-type applanation tonometry.

6. Advise people with IOP below 24 mmHg to continue regular visits to their primary eye care professional. 

No Referral Criteria Listed