4.3.4. Patient Suitability

Table 7 provides an overview of new patients who are considered suitable and unsuitable for each VC.


**Table 7.** The characteristics that render patients suitable or unsuitable for each virtual clinic.

Abbreviations: FU = follow-up; NG/OSR = new glaucoma/OHT suspect referrals; G = glaucoma patient; OHT = ocular hypertension patient; GS = glaucoma suspect patient; PDS = pigment dispersion syndrome; PXF = pseudoexfoliation syndrome; All NG/OSR \* = all risks of developing glaucoma; H = history of; IOP = intra-ocular pressure; VA = visual acuity; VF = visual field; NS = not specified; VC = virtual clinic; GCC = glaucoma classifying clinic; GSC = Glaucoma Screening Clinic; SMS = Stable Monitoring Service; GSMS = Glaucoma Screening and Stable Monitoring Service; GAC = Glaucoma Assessment Clinic; PAEP = Princess Alexandra Eye Pavilion; MREH = Manchester Royal Eye Hospital; BEH = Bristol Eye Hospital; REIP = The Royal Eye Infirmary Plymouth. PCAG = Primary closed-angle glaucoma.

New Patients

• Suitable:

At the start of the GSC, only "low risk" glaucoma suspects were considered to be suitable [49]. These patients only had one of the following risk factors: suspicious optic discs, suspicious VF or IOP >20 mm Hg. In a second stage, "low-to-moderate risk" glaucoma suspects (having up to two risk factors, including and a positive family history in a first-degree relative) were also eligible for the GSC [49]. Finally, at a later stage, patients could have up to three of those risk factors and still be eligible for the GSC [49]. A clinician decided if a patient would be included in the VC or would be sent to the GE immediately. In the GAC, all new glaucoma/OHT suspect referrals were included in the VC [46,48].

• Unsuitable:

The clinician excluded new glaucoma/OHT suspect referrals from the GSC if they did not meet the inclusion criteria [49]. Patients were also excluded if they showed definitive signs of glaucoma, were angle-closure suspects or were referred with an IOP >32 mm Hg [49]. If a patient showed an IOP >32 mm Hg at the initial assessment of the GSC, the patient would be sent to a GE on the same day [49].

Follow-Up Patients

• Suitable:

Only stable patients with a low risk of glaucomatous damage progression were suitable for the SMS [56–58]. In the "pilot" study by Clarke et al., patients were included if their planned follow-up frequency was more than six months [56]. This study concluded that patients were suitable if they had stable glaucoma and were at low risk of progression to significant visual loss over each follow-up interval [56]. Recent studies conducted by Nikita et al. expanded patient suitability from glaucoma suspects and low-risk glaucoma to most types of glaucoma and in various stages of disease progression, and provided firm evidence that expanded patient eligibility criteria are able to deliver high-quality glaucoma care that is safe and effective [58,60]. In the GCC, patients were taken from the general follow-up pool and could have any type of glaucoma at any stage [51]. In the VC-PAEP, patients with mild to moderate stable open-angle glaucoma or patients with mild to moderate stable primary closed-angle glaucoma who are bilaterally pseudophakic were suitable [52,53].

• Unsuitable:

In the "pilot" study of the SMS, patients were excluded if they had poor mobility or if the quality of their VF or fundus photographs was poor [56]. When the SMS was eventually established, other exclusion criteria were added, including monocular, concurrent eye diseases/morbidities, a low VA and if there were concerns about the patients' adherence to treatment [57]. The expanded monitoring service studied by Nikita et al. did not specify the exclusion criteria [58]. Both the SMS and the VC-PAEP excluded phakic angleclosure glaucoma/glaucoma suspects and patients who had a history of glaucoma filtration surgery [52,53,57].
