How well do Australian and New Zealand optometrists follow clinical guidelines in glaucoma diagnosis?

Aug 11, 2014

How well do Australian and New Zealand optometrists follow clinical guidelines in glaucoma diagnosis?

The solid foundation of Australian and New Zealand optometrists holds high promises that the profession is moving in the right direction to counter the lingering threat of increasing visual impairment from chronic eye disorders, according to a new study by the Centre for Eye Health.

During late 2012/early 2013 the Centre for Eye Health at UNSW Australia conducted a major survey of Australian and New Zealand optometrists regarding glaucoma assessment with the help of Optometry Australia and the New Zealand Association of Optometrists. The aim of the project was to evaluate the access to, confidence with and application of tests required for a comprehensive glaucoma assessment in compliance with guidelines.

We are very pleased to announce that the first part in a series of papers has been accepted for publication in the September issue of the peer-reviewed journal Ophthalmic & Physiological Optics”, said Dr. Barbara Zangerl, Research Fellow at CFEH.

The key findings indicate:

  • Generally ready access to and confidence with necessary instruments in both countries with some exceptions. The availability and confidence in undertaking pachymetry and gonioscopy is lower than other techniques.
  • Adjunct imaging techniques are not readily available in optometric practice. Nevertheless, 23-32% of optometrists are currently using ocular coherence tomography, which is well on its way to be incorporated in standard optometric practice.
  • Optometrists are more confident with techniques that they were exposed to during core training, for example younger practitioners reported more confidence in slit lamp fundoscopy, whereas practitioners with more years of experience were more confident with direct ophthalmoscopy.
  • Findings were irrespective of practice location, demographic features or patient throughput, howevertherapeutically endorsed optometrists were identified as having a higher level of access and confidence in applying and interpreting individual tests.

Taken together, the key findings of the study strongly emphasised the importance of continued education with advanced training opportunities, ideally including practical components to foster confident and safe application of techniques.

In clinical areas that are expected to undergo periodic changes in methodology, such as glaucoma diagnosis and management, even hurdle assessments may be indicated to ensure appropriate up skilling of practicing optometrists.

Entry-level requirements as outlined by the Optometry Council of Australia and New Zealand require optometrists to be competent in the use of gonioscopy, pachymetry and imaging modalities. It is often assumed that this entry-level requirement is for those entering the profession: this is not so.

“Entry level is the current standard of care of practicing optometrists. Therapeutic endorsement allows the optometrist to prescribe suitable medication but diagnosis is the domain of all practicing optometrists”, said Centre Director, Prof. Michael Kalloniatis.


Jamous KF, Kalloniatis M, Hayen A, Mitchell P, Stapleton FJ, and Zangerl B Application of clinical techniques relevant for glaucoma assessment by optometrists: concordance with guidelines, Ophthalmic and Physiological Optics (doi: 10.1111/opo.12146 September 2014 issue)