Attitudes of consultant ophthalmologists in the UK to initial management of glaucoma patients presenting with severe visual field loss: a national survey

Richard Stead, Augusto Azuara-Blanco, Anthony J. King*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

13 Citations (Scopus)


Background: Recent National Institute of Clinical Excellence guidance suggests primary surgery should be offered to patients presenting with glaucoma with severe visual field loss. We undertook a survey of UK consultant ophthalmologists to determine if this represents current practice and explore attitudes towards managing patients with advanced glaucoma at presentation.

Design: Questionnaire evaluation study.

Participants: All consultant ophthalmologists currently practicing in the UK.

Methods: A single-page questionnaire was posted to all consultants (n = 910) currently practicing in the UK along with a pre-paid return envelope. A second questionnaire was sent to non-responders (n = 459).

Main Outcome Measures: Questionnaire responses.

Results: 626 responses were received representing 68.8% of the population surveyed. 152 (24%) volunteered a specialist interest in glaucoma. Consensus opinion for both glaucoma specialists (64.9%) and non-glaucoma specialists (62.4%) was to start with primary medical therapy, most commonly citing surgical risk as the primary reason (23% and 22%, respectively) for this approach. Most felt the highest intraocular pressure measurement during follow up (measured in clinic) was the most important variable for prevention of further visual loss (60% of glaucoma specialists and 55% of non-glaucoma specialists). Eighty-three per cent of all responders suggested they would change their practice if evidence supporting primary surgery as a safe and more effective approach existed.

Conclusions: Recent National Institute of Clinical Excellence guidance does not reflect the current management approach of UK ophthalmologists. The primary concern was related to potential complications of surgery although most practitioners would be willing to change their practice if evidence existed supporting primary surgery in patients presenting with advanced glaucoma.

Original languageEnglish
Pages (from-to)858-864
Number of pages7
JournalClinical & Experimental Ophthalmology
Issue number9
Early online date14 Jun 2011
Publication statusPublished - Dec 2011
EventMeeting of the UK-and-Eire-Glaucoma-Society - Liverpool, United Kingdom
Duration: 1 Dec 2009 → …


  • advanced glaucoma
  • intraocular pressure
  • trabeculectomy
  • open-angle glaucoma
  • randomized clinical-trial
  • intraocular-pressure
  • filtration surgery
  • mitomycin-C
  • risk-factors
  • progression
  • 5-fluorouracil
  • medication

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