The false negative rate and the role for virtual review in a nationally evaluated glaucoma referral refinement scheme

Purpose To establish the safety of the CHANGES glaucoma referral refinement scheme ( GRRS ). Methods The CHANGES scheme risk stratifies glaucoma referrals, with low risk referrals seen by a community based specialist optometrist ( OSI ) while high risk referrals are referred directly to the hospital. In this study, those patients discharged by the OSI were reviewed by the consultant ophthalmologist to establish a ‘false negative’ rate ( Study 1 ). Virtual review of optic disc photographs was carried out both by a hospital‐based specialist optometrist as well as the consultant ophthalmologist ( Study 2 ). Results None of these 34 discharged patients seen by the consultant were found to have glaucoma or started on treatment to lower the intra‐ocular pressure. Five of the 34 (15%) were classified as ‘glaucoma suspect’ based on the appearance of the optic disc and offered a follow‐up appointment. Virtual review by both the consultant and optometrist had a sensitivity of 80%, whilst the false positive rate for the optometrist was 3.4%, and 32% for the consultant ( p  < 0.05). Conclusions The false negative rate of the OSI s in the CHANGES scheme was 15%, however there were no patients where glaucoma was missed. Virtual review in experienced hands can be as effective as clinical review by a consultant, and is a valid method to ensure glaucoma is not missed in GRRS . The CHANGES scheme, which includes virtual review, is effective at reducing referrals to the hospital whilst not compromising patient safety.