A survey of primary angle closure knowledge and application by UK community-based optometrists

Abstract Introduction In 2022, UK guidance on the management and referral of primary angle closure (PAC) was published by the Royal College of Ophthalmologists (RCO) and the College of Optometrists (CoO). This study sought to investigate PAC knowledge and guidelines adherence of community-based optometrists (CBO). Methods An online survey was sent to CBO in July 2023 that asked about professional status, PAC investigations/risk factors, guideline application, and referral thresholds. Results Fifty-seven CBO with a median post-qualification experience of 19.0 years (IQR 9.3.4-24.8)completed the survey. Twenty-eight (49.1%) had a post-graduate qualification in glaucoma. A mean number of 4.8 95% CI (4.3-5.2) risk factors for PAC were identified. Thirty-two (56.1%) reported using the RCO and CoO guidelines, 38 (66.6%) reported referral of asymptomatic patients with risk factors and/or acute angle closure symptoms (AACS) with a limbal anterior chamber depth of grade 1, but 35 (61.4%) would refer on grade 1 alone. Confidence in monitoring a diagnosed PAC-suspect in the community was moderate using a 10-point Likert scale, median 7 (IQR 6-8). Thirty-seven (64.9%) would re-refer to the hospital eye service based on either IOP or AACS. Access to anterior segment optical coherence tomography was available to 37 (64.9%) optometrists where 16 (28.1%) had received training. Conclusion This study found there was moderate use of current guidelines for investigating of and onward referral for PAC. Our findings recommend further professional development in PAC for CBO. Further work is required to determine whether PAC guidelines have affected both the numbers and quality of referrals.