Frequency of visual field testing when monitoring patients newly diagnosed with glaucoma: mixed methods and modelling

摘要: Background Visual field (VF) tests are the benchmark for detecting and monitoring eye disease glaucoma. Measurements from VF variable, which means that frequent monitoring, perhaps over a long period of time, is required to accurately detect true glaucomatous progression. In 2009, guidelines diagnosis management glaucoma issued by National Institute Health Care Excellence revealed an absence research evidence about clinical effectiveness cost-effectiveness using different intervals However, European Glaucoma Society (EGS) on patient examination recommend newly diagnosed patients should undergo testing three times per year in first 2 years after initial diagnosis. Objectives The primary objective this project was explore progression patients. Other objectives sought (1) patients’ views experiences focus groups; (2) establish subspecialists’ attitudes regarding frequency five-item questionnaire. Design These questions were investigated multicentre audit current practice existing NHS data (VF records almost 90,000 patients). New knowledge provided through statistical health economic modelling these additional published data. Results showed is, average, carried out annually. Patient groups indicated that, although do not like testing, they accept it as critical part their care. Patients raised concerns distracting environments, quality instructions, explanation results excessive waiting times. Questionnaires clinicians’ towards varied considerably, many specialists believed recommendations impractical. Statistical suggested EGS could be clinically effective can identified sooner than possible with annual testing. increased may also cost-effective [incremental ratio (ICER) equal £21,679]. Conclusions suggests there strong rationale following benefit providing better information fast-progressing Our model increasing (ICER £21,679), especially when accounting gains society. Nevertheless, clinicians consider impossible resources. addition, practicalities delivery tests. Future work study inform design prospective randomised comparative trial linked stratifying according risk factors further developed used practical tool optimising individualised follow-up. indicate service important issue worthy investigation. Ensuring confidence co-operation at centre future into most efficient strategies monitoring. Funding This funded Research Services Delivery programme.