Increases in the aging population has resulted in increased demand for glaucoma services. Glaucoma is a disease that if untreated, can lead to blindness. This increase and need for long term treatment with monitoring have resulted in a significant demand in the hospital eye service (HES). Many departments are now facing a considerable backlog of outpatient appointments and it's essential that these appointments are reserved for patients who are at risk of glaucoma blindness.

Primary angle closure (PAC) glaucoma is a type of glaucoma, where the drainage route for the fluid inside the eye (known as the angle) is narrowed or blocked. It has been recently identified that approximately half of patients referred into the HES for a suspect narrow angle for further investigation are healthy and are immediately discharged. The exact reasons for these findings are unknown.

This project will investigate clinical decisions by community optometrists who account for the majority of PAC referrals into the HES, as well as assessing their ability to evaluate those at risk of PAC. This project will also examine whether clinical agreement could be improved by providing an educational package.

A clinical image database of angles will be acquired from glaucoma patients attending Moorfields Eye Hospital. A learning package discussing angle closure referral will also be developed. Community optometrists will be invited to complete a questionnaire on their clinical decision making. This will be followed by the vignette assessment, learning package and re-assessment.

If this educational package and/or any other identifiers are found to improve agreement levels, this could reduce the number of referrals and enable community monitoring of those at low risk of developing PAC glaucoma in their lifetime.

Inclusion Criteria:

New patients attending the glaucoma clinic at Moorfields Eye Hospital

Exclusion Criteria:

• They cannot be examined using a table mounted slit lamp due to physical limitations or have gross nystagmus.
• Unable to consent
• If they are unable to communicate in English and there is no available interpreter that meets requirements set out by Moorfields standard operating policies for patients
• Under 18 years old

New patients to the glaucoma service will be selected as they would be a real-world reflection of those who have been identified at risk of developing glaucoma that have been referred for glaucoma investigation within the hospital eye service from primary care. Furthermore, they would have an enriched sample of narrow angles that are required to achieve the desired the case-mix required for the image database within the set timelines.