The guideline adherence of optometrists when assessing and referring a patient with primary open-angle glaucoma

Glaucoma is a group of diseases that will lead to blindness if left untreated. With early detection, treatment, patient education, and referral for consultation or treatment by an ophthalmologist when indicated it is possible to reduce the risk of vision loss. For this reason, the knowledge of the disease and the right assessment and examinations are essential to optometrists who create a broad network of eye health professionals in Finland. Guidelines provide evidence-based knowledge regarding all aspects of glaucoma care. The purpose of the clinical guidelines for optometrists is to provide appropriate examination and treatment protocols. The purpose of this master’s thesis was to improve the knowledge of Finnish optometrists about the assessment of primary open-angle glaucoma (POAG) patients. This thesis contains two sections: integrative literature review and the development of a guideline. The purpose of the research section was to map optometrists’ adherence to glaucoma guidelines. The aim was to observe changes in performing comprehensive eye examinations and to discover the factors that affect the adherence. The purpose of the development section was to create a guideline for Finnish optometrists about POAG patients’ assessment. The development of the guideline was based on pre-existing glaucoma guidelines, integrative literature research, and a workshop development method. The integrative literature research revealed high compliance to visual acuity measurements, biomicroscopy of the anterior segment, intraocular pressure measurements and optic nerve head assessment. Adherence was low in performing gonioscopy and with the use of the Goldman applanation tonometry. Glaucoma guidelines did increase the adherence to the applanation tonometry, optic disc evaluations and imaging, and the accuracy of the right susception of POAG patients which led to earlier diagnosis and management. Education, feedback, a team care model, and pre-designed assessment sheets were found to be aspects increasing adherence. These are also the aspects to consider when implementing the Finnish glaucoma guidelines. The education of the optometrists is a key factor that will increase compliance with new guidelines. Knowledge of the disease and the existing guidelines with a user-friendly guideline will improve the optometrists’ skills and compliance with high-quality examinations and referrals. With Finnish laws and regulations, it is important to notice the importance of cooperation with ophthalmologists when creating guidelines and determining the threshold values for referring patients. Open discussion and new ways of thinking and organizing eye health services will benefit the scope of eye health and lead to high-quality services