Referral source, symptoms, and severity at diagnosis of ocular hypertension or open-angle glaucoma in various practices

Objective: To evaluate the severity of glaucoma at presentation and the relationship to referral source and presenting symptoms. Design: Prospective, multicentre, cross-sectional, study. Participants: Patients newly diagnosed with ocular hypertension (OH) or open-angle glaucoma (OAG). Methods: Eligible subjects underwent comprehensive ocular examinations, including medical histories and presenting symptoms. The referral source was also documented. Patients were classified as OH or mild, moderate, or advanced OAG. The proportion of subjects in each disease category was determined and compared for differences in demographics, ocular findings, referral sources, and presenting symptoms. Results: We enrolled 404 subjects; 113 (28%) were diagnosed as having OH and 291 (72%) as having OAG. In the OAG group 151 (52%) had mild, 79 (27%) moderate, and 61(21%) advanced disease at initial diagnosis. The majority of the referrals were from optometrists (82%), followed by family physicians (7%) and ophthalmologists (7%). Referral patterns and presenting symptoms were significantly different for advanced disease as compared to the other severity levels (p = 0.03 and p 0.003, respectively). In more than half of the patients, the referral was made because of an abnormality noted by the referring source in an asymptomatic subject. Visual symptoms noted by the subject were more common in advanced OAG (23%) as compared to OH (9%), mild (4%), and moderate (9%) OAG. Conclusions: Nearly half of the patients with OAG had moderate or advanced disease at the time of initial diagnosis. Although optometrists were responsible for the majority of the referrals, the proportion was significantly less for advanced disease. These results raise the possibility of suboptimal detection services for glaucoma.