Evaluation of Clinical Decisions and Assessment of Those at Risk of Primary Angle Closure by Community Optometrists

NCT05543889 | Unknown

• 1 other identifier: JINA1001
• Study Type: observational
• Target: 163
• Locations: 1 country
• Sites: 1

Brief Summary

Increases in the aging population has resulted in increased demand for glaucoma services. Glaucoma is a disease that if untreated, can lead to blindness. This increase and need for long term treatment with monitoring have resulted in a significant demand in the hospital eye service (HES). Many departments are now facing a considerable backlog of outpatient appointments and it's essential that these appointments are reserved for patients who are at risk of glaucoma blindness. Primary angle closure (PAC) glaucoma is a type of glaucoma, where the drainage route for the fluid inside the eye (known as the angle) is narrowed or blocked. It has been recently identified that approximately half of patients referred into the HES for a suspect narrow angle for further investigation are healthy and are immediately discharged. The exact reasons for these findings are unknown. This project will investigate clinical decisions by community optometrists who account for the majority of PAC referrals into the HES, as well as assessing their ability to evaluate those at risk of PAC. This project will also examine whether clinical agreement could be improved by providing an educational package. A clinical image database of angles will be acquired from glaucoma patients attending Moorfields Eye Hospital. A learning package discussing angle closure referral will also be developed. Community optometrists will be invited to complete a questionnaire on their clinical decision making. This will be followed by the vignette assessment, learning package and re-assessment. If this educational package and/or any other identifiers are found to improve agreement levels, this could reduce the number of referrals and enable community monitoring of those at low risk of developing PAC glaucoma in their lifetime.

Conditions

Angle Closure Glaucoma

Keywords

Limbal anterior chamber depth; Optometrist; Angle-closure; Van Herick

Outcome Measures

Primary Outcomes (1)

• Agreement of community optometrists on measuring Limbal anterior chamber depth

  Levels of agreement and precision of optometrist observers before and after intervention of online educational package in assessment of Limbal anterior chamber depth as a surrogate measure of angle width. Agreement will be measured via an online assessment vignette assessment package. Weighted Kappa statistic and levels agreement will be the outcome measures

  12 months

Secondary Outcomes (2)

• Qualitative outcome measures from optometrists

  12 months

• Qualitative outcome measures from patients

  12 months

Study Arms (2)

Patients

100 patient participants will be recruited for limbal anterior chamber depth image capture. These images will be used to develop the clinical vignette database

Optometrists

50 optometrists will be recruited to undertake the clinical vignette assessment

Other: Educational package

Interventions

Educational package OTHER

Online learning package that will discuss the van Herick technique, grading, accuracy and information and discusses the current guidelines for primary angle closure suspect referral.

Optometrists

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

New patients to the glaucoma service will be selected as they would be a real-world reflection of those who have been identified at risk of developing glaucoma that have been referred for glaucoma investigation within the hospital eye service from primary care. Furthermore, they would have an enriched sample of narrow angles that are required to achieve the desired the case-mix required for the image database within the set timelines.

You may qualify if:

• New patients attending the glaucoma clinic at Moorfields Eye Hospital

You may not qualify if:

• They cannot be examined using a table mounted slit lamp due to physical limitations or have gross nystagmus.
• Unable to consent
• If they are unable to communicate in English and there is no available interpreter that meets requirements set out by Moorfields standard operating policies for patients
• Under 18 years old

Sponsors & Collaborators

• Moorfields Eye Hospital NHS Foundation Trust: lead

Study Sites (1)

Moorfields Eye Hospital NHS Foundation Trust, 162 City Road

London, EC1V 2PD, United Kingdom

Location

MeSH Terms

Conditions

Glaucoma, Angle-Closure

Condition Hierarchy (Ancestors)

Glaucoma; Ocular Hypertension; Eye Diseases

Study Officials

• Anish Jindal

  Moorfields Eye Hospital NHS Foundation Trust/UCL

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: September 13, 2022
• First Posted: September 16, 2022
• Study Start: December 7, 2022
• Primary Completion: March 7, 2024
• Study Completion: March 7, 2024
• Last Updated: February 23, 2024

Record last verified: 2023-12

Data Sharing

• IPD Sharing: Will not share

Locations

GB (1)