Ophthalmologist and Optometrist Co-management Model for Glaucoma: Outcomes from a Single Tertiary Care Health Center.
Publication/Presentation Date
2-25-2026
Abstract
PURPOSE: The growing demand for eye care poses significant challenges to the effective management of patients with glaucoma. This study evaluated long-term clinical outcomes of patients with glaucoma co-managed by institutionally trained optometrists and glaucoma specialists at UCSF.
DESIGN: Retrospective cohort study.
PARTICIPANTS: Patients with glaucoma suspect or stable glaucoma diagnoses from 2016-2023.
METHODS: Patients were co-managed by glaucoma specialists and optometrists with postgraduate institutional glaucoma-specific training via either "alternate care" (alternating glaucoma specialist and optometrist visits) or "transfer care" (optometrist visits only) for up to 5 years of follow-up. Generalized linear models were used to assess long-term changes in clinical parameters.
MAIN OUTCOME MEASURES: Changes in intraocular pressure (IOP), best-corrected visual acuity (BCVA), medications, Humphrey visual field (HVF), and OCT retinal nerve fiber layer (RNFL).
RESULTS: The study included 391 patients (775 eyes), with 136 (34.8%) in alternate care and 255 (65.2%) in transfer care. The most common diagnoses were glaucoma suspect (51.2%) and primary open-angle glaucoma (POAG, 36.0%). No significant changes were observed in BCVA (p=0.34), IOP (p=0.18), medications (p=0.11), or RNFL (p=0.65) while mean deviation of HVF improved (p=0.003) over 5 years among both groups. Overall, 132 eyes (17.0%) required treatment escalation: 81 (10.5%) needed increased medications, 34 (4.4%) underwent glaucoma-related laser treatment, and 17 (2.2%) had incisional surgery. Among all eyes, 56 (14.3%) were re-referred to glaucoma specialists, with 43 (11.0%) returning to co-management after evaluation or treatment. Alternate care patients saw both optometrists and glaucoma specialists a median of once per year while transfer care patients saw optometrists a median of twice per year and none by glaucoma specialists. In multivariable analysis, escalation was associated with older age (OR 1.30 per decade; 95% CI 1.04-1.63; p=0.02), POAG vs suspect (OR 2.99; 95% CI 1.59-5.65; p< 0.001), and higher baseline IOP (OR 1.18 per mmHg; 95% CI 1.07-1.30; p=0.01). The care pathway of each patient was not significantly associated with treatment escalation.
CONCLUSION: With appropriate training, a well-defined and closely monitored co-management model can maintain patient safety and glaucoma stability over five years with improved resource allocation and reduced utilization of glaucoma specialists.
ISSN
2589-4196
Published In/Presented At
Chen, E. M., Chan, S., Chen, K. J., Kuchhangi, A., Huh, M. D., Liang, J., Takla, P. M., Pak, E., Lu, J. H., Vadivel, A., Chen, D., Oatts, J., Shan, J., Yu, Y., Ying, G. S., Stein, J. D., Aung, T., Litvin, T., & Han, Y. (2026). Ophthalmologist and Optometrist Co-management Model for Glaucoma: Outcomes from a Single Tertiary Care Health Center. Ophthalmology. Glaucoma, S2589-4196(26)00019-0. Advance online publication. https://doi.org/10.1016/j.ogla.2026.02.002
Disciplines
Medicine and Health Sciences | Pediatrics
PubMedID
41759627
Department(s)
Department of Pediatrics
Document Type
Article