Glaucoma - Suspected LWP

Surgery > Ophthalmology > Glaucoma - LWP

Glaucoma - Suspected

1st Assessment

Other Clinical
Glaucoma Suspected
reason

Field Defect

A mean result of
>21mmHg

Repeat Field Test if

IOP normal

IOP Retest

A mean result of
>21mmHg

Field Defect
IOP Retest

A mean result of
>21mmHg

Suspect Glaucoma/
Ocular Hypertension

GOS18

Referral to Specialist
R

Full Assessment

Locally reviewed:

Due for review:

Printed on: 02-Jun-2010

Map of Medicine Ltd

IMPORTANT NOTE
Locally reviewed refers to the date of completion of the most recent review process for a pathway. All pathways are reviewed regularly every
twelve months, and on an ad hoc basis if required. Due for review refers to the date after which the pathway on this page is no longer valid
for use. Pathways should be reviewed before the due for review date is reached.

Page 1 of 4

Glaucoma - Suspected LWP

Surgery > Ophthalmology > Glaucoma - LWP

1 Glaucoma - Suspected
Quick info:
Patient may present for a routine eye test.
Patient is referred to the optometrist after complaining of blurred vision.

2 1st Assessment
Quick info:
The patient will visit an appropriately qualified health care professional where routine testing suggests glaucoma/ ocular
hypertension may be present.
Please use Algorithm 1 for assessment, which is NICE approved.
Please click here for Algorithm 1
NICE recommend measuring the Goldmann applanation tonometry (GAT IOP) twice for every patient to reduce the number of false
positive referrals.
If using non-contact tonometers practioners should take four readings per eye and use the mean as the result. Only when the mean
result is >21 mmHg should the practioner consider referring the patient for further assessment if this is the only abnormality found.
Reducing the number of readings per eye increases the chance of recording a mean result of >21mmHg in eyes of normal persons
with GAT IOPs of <21mmHg.
Reference:
National Institute for Health and Clinical Excellence (NICE). Glaucoma: Diagnosis and management of chronic open angle glaucoma
and ocular hypertension. London: NICE; 2009
Vernon SA D J Henry S J Jones L Cater, Maximising the sensitivity and specificity of non-contact tonometry in glaucoma screening,
Eye 1991 - 5 491- 3.

5 A mean result of >21mmHg

Quick info:
Practitioners may consider not referring patients at low risk of significat visual field loss in thier lifetime Pts aged 80yrs with measured IOPs <26mmHg with itherwise normal ocular examinations (normal discs, fields and van
Herick).
Pts 65 with ,25mmHg and with otherwise normal ocular examinations(normal discs, fields and van Herick).
These groups do not qualify for treatment under current NICE guidance. Such pts may be advised that they should be reviewed by
an appropriately qualified health care professional every 12mths.
Reference:
College of Optometrists(2009) Guidance on the referral of Glaucoma suspects by community optometrists.
National Collaborating Centre for Acute Care (2009), Glaucoma:Diagnosis and management of chronic open angle glaucoma
andocular hypertension commissioned by the National Institute for Health and Clinical Excellence (NICE)London: NICE; 2009
Local Optical Committee (LOC) support unit (2009) Glaucoma Referral Refinement and OHT Enhanced Service Pathways following
updated NICE guidance (April 2009)

6 Repeat Field Test if IOP normal

Quick info:

Locally reviewed:

Due for review:

Printed on: 02-Jun-2010

Map of Medicine Ltd

IMPORTANT NOTE
Locally reviewed refers to the date of completion of the most recent review process for a pathway. All pathways are reviewed regularly every
twelve months, and on an ad hoc basis if required. Due for review refers to the date after which the pathway on this page is no longer valid
for use. Pathways should be reviewed before the due for review date is reached.

Page 2 of 4

Glaucoma - Suspected LWP

Surgery > Ophthalmology > Glaucoma - LWP

Tthe repeat field test should be at least 60 points.

7 IOP Retest
Quick info:
NICE recommend measuring the Goldmann applanation tonometry (GAT IOP) twice for every patient to reduce the number of false
positive referrals and therefore the retest should be carried out using GAT.
Reference:
National Institute for Health and Clinical Excellence (NICE). Glaucoma: Diagnosis and management of chronic open angle glaucoma
and ocular hypertension. London: NICE; 2009
Vernon SA D J Henry S J Jones L Cater, Maximising the sensitivity and specificity of non-contact tonometry in glaucoma screening,
Eye 1991 - 5 491- 3.

10 IOP Retest
Quick info:
This retest only needs to take place if the 1st assessment was carried out using a non contact tonometer.
NICE recommend measuring the Goldmann applanation tonometry (GAT IOP) twice for every patient to reduce the number of false
positive referrals.
Reference:
National Institute for Health and Clinical Excellence (NICE). Glaucoma: Diagnosis and management of chronic open angle glaucoma
and ocular hypertension. London: NICE; 2009
Vernon SA D J Henry S J Jones L Cater, Maximising the sensitivity and specificity of non-contact tonometry in glaucoma screening,
Eye 1991 - 5 491- 3.

Locally reviewed:

Due for review:

Printed on: 02-Jun-2010

Map of Medicine Ltd

IMPORTANT NOTE
Locally reviewed refers to the date of completion of the most recent review process for a pathway. All pathways are reviewed regularly every
twelve months, and on an ad hoc basis if required. Due for review refers to the date after which the pathway on this page is no longer valid
for use. Pathways should be reviewed before the due for review date is reached.

Page 3 of 4

Glaucoma - Suspected LWP

Surgery > Ophthalmology > Glaucoma - LWP

Key Dates
Due for review:
Locally reviewed: , by
Updated: 02-Jun-2010

Locally reviewed:

Due for review:

Printed on: 02-Jun-2010

Map of Medicine Ltd

IMPORTANT NOTE
Locally reviewed refers to the date of completion of the most recent review process for a pathway. All pathways are reviewed regularly every
twelve months, and on an ad hoc basis if required. Due for review refers to the date after which the pathway on this page is no longer valid
for use. Pathways should be reviewed before the due for review date is reached.

Page 4 of 4