Virtual Glaucoma Clinic: Do Consultants Agree on Management Outcomes?

Objective: To evaluate inter-examiner variations in glaucoma management amongst consultants with different levels of experience in Virtual Glaucoma Clinic. Methods: Three glaucoma specialist consultants with varying years of experience (1, 5 and 15 years) independently reviewed 112 consecutive cases. The management outcomes of the three consultants were recorded for each case on a specially designed proforma. Inter-consultant agreement on recall time, review place and treatment plan was analysed using kappa coefficient. The cohort was classified into two groups for further analysis. The first group consisted of patients in whom all three consultants agreed on management outcomes. The second group consisted of patients in whom at least one consultant disagreed on management outcomes. Unpaired student-t-test was used to calculate the difference in mean values of age, visual acuity, intraocular pressure, cup-todisc ratio and visual field mean deviation between both groups for each management outcome. Results: The percentage of overall agreement on recall time (25%) and review place (45%) was fair and moderate respectively. The overall agreement on treatment plan was superior (86%). We found significant disagreement between the senior consultant and the newly appointed consultant with lowest Kappa agreement on recall time and on review place (κ 0.14 and κ 0.22 respectively). On overall, the level of complete agreement amongst ocular hypertension was best when compared to glaucoma suspect and glaucoma. Statistical analysis revealed a tendency for disagreement amongst consultants’ management outcomes on patients having more abnormal visual field and raised intraocular pressure. Conclusions: Our study demonstrates that greater difference in years of experience between consultants is associated with more disagreement in management outcomes. Discrepancies on management outcomes impact on uniformity of care and service delivery in a virtual clinic setting. We suggest the need for implementing structured management guidance in virtual glaucoma clinic to reduce discrepancies amongst consultants.