Ophthalmologist and Optometrist Comanagement Model for Glaucoma: Outcomes from a Single Tertiary Care Health Center.

Purpose

The growing demand for eye care poses significant challenges to the effective management of patients with glaucoma. This study evaluated long-term clinical outcomes of patients with glaucoma comanaged by institutionally trained optometrists and glaucoma specialists at the University of California San Francisco.

Design

Retrospective cohort study.

Participants

Patients with glaucoma suspect or stable glaucoma diagnoses from 2016 to 2023.

Methods

Patients were comanaged by glaucoma specialists and optometrists with postgraduate institutional glaucoma-specific training via either "alternate care" (alternating glaucoma specialist and optometrist visits) or "transfer care" (optometrist visits only) for up to 5 years of follow-up. Generalized linear models were used to assess long-term changes in clinical parameters.

Main outcome measures

Changes in intraocular pressure (IOP), best-corrected visual acuity (BCVA), medications, Humphrey visual field (HVF), and retinal nerve fiber layer (RNFL) thickness.

Results

The study included 391 patients (775 eyes), with 136 (34.8%) in alternate care and 255 (65.2%) in transfer care. The most common diagnoses were glaucoma suspect (51.2%) and primary open-angle glaucoma (POAG, 36.0%). No significant changes were observed in BCVA (P = 0.34), IOP (P = 0.18), medications (P = 0.11), or RNFL (P = 0.65) whereas the mean deviation of HVF improved (P = 0.003) over 5 years among both groups. Overall, 132 eyes (17.0%) required treatment escalation: 81 (10.5%) needed increased medications, 34 (4.4%) underwent glaucoma-related laser treatment, and 17 (2.2%) had incisional surgery. Among all eyes, 56 (14.3%) were rereferred to glaucoma specialists, with 43 (11.0%) returning to comanagement after evaluation or treatment. Alternate care patients saw both optometrists and glaucoma specialists at a median rate of once per year. Transfer care patients saw optometrists at a median rate of twice per year and none by glaucoma specialists. In multivariable analysis, escalation was associated with older age (odds ratio [OR], 1.30 per decade; 95% CI, 1.04-1.63; P = 0.02), POAG vs. suspect (OR, 2.99; 95% CI, 1.59-5.65; P < 0.001), and higher baseline IOP (OR, 1.18 per mmHg; 95% CI, 1.07-1.30; P = 0.01). Care pathway assignment was not significantly associated with treatment escalation.

Conclusions

A well-defined and closely monitored comanagement model can maintain patient safety and glaucoma stability over 5 years with improved resource allocation and reduced utilization of glaucoma specialists.

Financial disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.