AAO preferred practice patterns often overlooked

A retrospective chart review of 200 charts from three centers found that physicians do not adhere consistently to the American Academy of Ophthalmology's Preferred Practice Patterns for glaucoma management. As the world's leading cause of irreversible blindness, the stakes are high to ensure that the patterns are being followed to maximize positive outcomes for patients with glaucoma.

Key Points

"An ignorant doctor is the aide-de-camp of death."-Avicenna (981-1037)

Brooklyn, NY-Are ophthalmologists consistently following the American Academy of Ophthalmology's (AAO's) preferred practice patterns (PPPs) to help prevent blindness in their glaucoma patients, or is there room for improvement? A recent study indicates that often the latter is the case.

Habeeb Ahmad, MD, a second-year resident in the Department of Ophthalmology at the State University of New York (SUNY) Downstate, Brooklyn, NY, and his colleagues conducted a retrospective review of 200 charts accounting for 259 visits at three centers for patients with open-angle glaucoma, suspected glaucoma, and angle-closure glaucoma. They found that practice patterns for these patients varied on numerous processes of care and between different academic settings.

Dr. Ahmad cited the World Health Organization's 2002 data for the distribution of blindness.

Cataracts, at 47%, easily rank as the number one cause, with glaucoma a distant second at 12%.

He noted, however, that glaucoma ranks number one in irreversible blindness, thus making the stakes-and the need for proper care practices-much higher.

"We know that open-angle glaucoma accounts for more than 2.2 million cases in the United States and [that] primary glaucomas account for 67 million worldwide, and we also know the specific risk factors," Dr. Ahmad said. "But, more importantly, we also know that with adequate screening, medical management, and even surgery, we can delay or prevent blindness."

The risk factors for patients developing the disease are well known: age, race, IOP, decreased corneal thickness, and family history. Dr. Ahmad said although those risk factors may contribute to a person developing glaucoma, another serious risk factor can adversely affect the course of the disease in patients: lack of education.

"We know that the more educated our patients are, the better they will adhere to our treatment plans," he said. "In fact, literacy of patients actually corresponds with adherence in glaucoma therapy."1

Patients whose charts were studied by Dr. Ahmad and his colleagues met the following inclusion criteria: age 18 to 90 years; diagnosis of open-angle glaucoma, suspected glaucoma, or angle-closure glaucoma; initial or follow-up visit after September 2005 (when the most recent AAO PPPs were issued); and legible charts. Excluded were children, patients with open-angle glaucoma with known secondary causes, patients using topical corticosteroids, patients in whom glaucoma was diagnosed in a postoperative period, and those whose charts were illegible.

The AAO's PPPs are designed to identify characteristics and components of quality eye care. Developed by the AAO's Quality of Care and Knowledge Base Development Secretariat and the PPP Committee, they provide guidance for the pattern of practice, not for the care of a particular individual, according to the AAO. They are available for downloading at http://one.aao.org/CE/PracticeGuidelines/PPP.aspx.