{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T05:26:23Z","timestamp":1784784383325,"version":"3.55.0"},"reference-count":56,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2018,2,28]],"date-time":"2018-02-28T00:00:00Z","timestamp":1519776000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Association of Optometrists Ireland"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ophthalmic Physiologic Optic"],"published-print":{"date-parts":[[2018,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>\n                      Glaucoma referral refinement (\n                      <jats:styled-content style=\"fixed-case\">GRR<\/jats:styled-content>\n                      ) has proven a successful demand management strategy for glaucoma suspect cases in the United Kingdom (\n                      <jats:styled-content style=\"fixed-case\">UK<\/jats:styled-content>\n                      ). A\n                      <jats:styled-content style=\"fixed-case\">GRR<\/jats:styled-content>\n                      clinic was established in Dublin, Ireland to investigate the clinical viability of this pathway outside the\n                      <jats:styled-content style=\"fixed-case\">UK<\/jats:styled-content>\n                      's National Health Service (\n                      <jats:styled-content style=\"fixed-case\">NHS<\/jats:styled-content>\n                      ) structures, and away from the influence of National Institute for Clinical Excellence (\n                      <jats:styled-content style=\"fixed-case\">NICE<\/jats:styled-content>\n                      ) guidance.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Glaucoma suspect patients were recruited into the scheme following referral from community optometrists in the greater Dublin area. The\n                      <jats:styled-content style=\"fixed-case\">GRR<\/jats:styled-content>\n                      exam protocol was designed in consultation with the participating ophthalmology department. The refinement scheme optometrist, trained through apprenticeship style experience at a hospital outpatient clinic, made a tentative management decision after carrying out the\n                      <jats:styled-content style=\"fixed-case\">GRR<\/jats:styled-content>\n                      exam. The final management decision was made in a \u2018virtual clinic\u2019 by a glaucoma specialist consultant ophthalmologist.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Two hundred and twenty\u2010five glaucoma suspect patients were seen in the scheme. After their first\n                      <jats:styled-content style=\"fixed-case\">GRR<\/jats:styled-content>\n                      visit, 28% were discharged back to their own optometrist, 42% were monitored in the\n                      <jats:styled-content style=\"fixed-case\">GRR<\/jats:styled-content>\n                      clinic, and 30% were referred to ophthalmology. After this monitoring cohort were further assessed, a total of 38% of the patients seen within the scheme required referral to ophthalmology. Sixteen percent of the total participant group (\n                      <jats:italic>n<\/jats:italic>\n                      = 225) were lost to follow up. Cohen's \u03ba was used to determine the level of agreement between the scheme optometrist and ophthalmologist. There was substantial agreement, with \u03ba = 0.63 for the first visit management decisions (\n                      <jats:italic>n<\/jats:italic>\n                      = 225). Agreement increased for subsequent monitoring visits with \u03ba = 0.85 for second visits (\n                      <jats:italic>n<\/jats:italic>\n                      = 65), and \u03ba = 0.69 for all management decisions within the scheme (\n                      <jats:italic>n<\/jats:italic>\n                      = 301). We received management outcomes for 44 of the 86 patients referred to ophthalmology. Of these 44, 57% received medical treatment for glaucoma, 34% were monitored without treatment, 2% were discharged, and 7% had comorbidities that were assessed and managed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Of the patients seen within the scheme, 62% did not require referral onward to ophthalmology, thus releasing the significant majority of hospital clinic slots that would previously have been required to examine such patients. The high level of inter\u2010professional decision agreement likely reflects the benefits of pre\u2010scheme apprenticeship style training and ongoing hospital clinic participation by the scheme optometrist. The rate of loss to follow up compares favourably with ophthalmology led, hospital based, glaucoma clinics. Nevertheless, the losses indicate that patient education remains a key priority for future planning.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/opo.12446","type":"journal-article","created":{"date-parts":[[2018,2,28]],"date-time":"2018-02-28T23:06:41Z","timestamp":1519859201000},"page":"400-410","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Glaucoma referral refinement in Ireland: managing the sensitivity\u2010specificity paradox in optometric practice"],"prefix":"10.1007","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6512-8887","authenticated-orcid":false,"given":"Catriona","family":"Barrett","sequence":"first","affiliation":[{"name":"Department of Optometry Dublin Institute of Technology (DIT) Dublin Ireland"},{"name":"DIT Centre for Eye Research Ireland Environmental Sustainability and Health Institute Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colm","family":"O'Brien","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Mater Misericordiae University Hospital Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Loughman","sequence":"additional","affiliation":[{"name":"Department of Optometry Dublin Institute of Technology (DIT) Dublin Ireland"},{"name":"DIT Centre for Eye Research Ireland Environmental Sustainability and Health Institute Dublin Ireland"},{"name":"African Vision Research Institute University of KwaZulu Natal Durban South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2018,2,28]]},"reference":[{"key":"e_1_2_9_2_1","first-page":"844","article-title":"Policy and practice","volume":"82","author":"Resnikoff S","year":"2004","journal-title":"Bull World Health Organ"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjo.2005.081224"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.3310\/hta11410"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.07-1501"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjo.2004.064378"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.07-0866"},{"key":"e_1_2_9_8_1","doi-asserted-by":"crossref","unstructured":"LayteR BarryM BennettKet al.Projecting the impact of demographic change on the demand for and delivery of health care in Ireland. 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