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Correspondence to Mr Hari Jayaram, Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK; [email protected]
Key message
What is already known on this topic
Risk stratification of glaucoma patients has been proposed to address the lack of capacity and prioritise resources in glaucoma services in the UK. The GLAUC-STRAT risk stratification tool currently in use has not been validated.
What this study adds
The GLAUC-STRAT risk stratification tool is MD driven and demonstrates a reasonable performance in risk stratifying eyes with open-angle glaucoma/ocular hypertension and in identifying an association with indices of hospital eye service resource use, but may not be adequate to be used in isolation.
How this study might affect research, practice or policy
Glaucoma risk stratification tools need to be carefully validated.
Introduction
Glaucoma is a leading cause of visual impairment (VI) in the UK, requiring regular monitoring by specially trained eye-care professionals. Despite a recent decrease in VI certifications related to age-related macular degeneration and diabetic retinopathy, the certification rate for glaucoma has remained unchanged.1 There are reports of severe vision loss attributed to the lack of capacity for timely monitoring of patients with glaucoma within the hospital eye service (HES).2 3 Monitoring of glaucoma patients has been further hindered by the COVID-19 pandemic, during which almost 30 000 glaucoma outpatient attendances were deferred at Moorfields Eye Hospital.4
To address the lack of capacity in the glaucoma services nationwide, new models of care have been proposed; community glaucoma monitoring schemes, improved referral refinement, management of glaucoma patients by appropriately trained non-medical professionals and the risk stratification of glaucoma patients have been proposed.5–8 The Healthcare Safety Investigation Branch has recommended further research into the development and evaluation of risk stratification tools, which would allow tailoring follow-up appointments to the patients’ clinical needs, while enabling the standardisation of practice across the National Health Service (NHS).8
The Glaucoma Risk Stratification Tool (GLAUC-STRAT) was adopted by the Royal College of Ophthalmologists (RCOphth) and the UK and Éire Glaucoma Society (UKEGS), for use as a stratification tool in the NHS glaucoma clinics but is yet to be supported by published validation studies. The LiGHT trial cohort includes carefully curated clinical data from 718 patients (1235 eyes) diagnosed with open-angle glaucoma...
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