A qualitative investigation into patients’ views on visual field testing for glaucoma monitoring

Objectives To investigate the views and experiences of patients regarding their glaucoma follow-up, particularly towards the type and frequency of visual field (VF) testing. Design A qualitative investigation using focus groups. The group discussion used broad open questions around the topics in a prompt guide relating to experiences of glaucoma follow-up, and in particular, VF monitoring. All the groups were taped, transcribed and coded using manual and computer-aided methods. Setting Three National Health Service (NHS) hospitals in England; two focus groups took place at each hospital. Participants 28 patients (mean (SD) age: 74 (9) years; 54% women) diagnosed with glaucoma for at least 2 years. Each focus group consisted of 3–6 patients. Primary and secondary outcomes (1) Attitudes and experiences of patients with glaucoma regarding VF testing. (2) Patients’ opinions about successful follow-up in glaucoma. Results These patients did not enjoy the VF test but they recognised the importance of regular monitoring for preserving their vision. These patients would agree to more frequent VF testing on their clinician's recommendation. A number of themes recurred throughout the focus groups representing perceived barriers to follow-up care. The testing environment, waiting times, efficiency of appointment booking and travel to the clinic were all perceived to influence the general clinical experience and the quality of assessment data. Patients were also concerned about aspects of patient–doctor communication, and often received little to no feedback about their results. Conclusions Patients trust the clinician to make the best decisions for their glaucoma follow-up. However, patients highlighted a number of issues that could compromise the effectiveness of VF testing. Addressing patient-perceived barriers could be an important step for devising optimal strategies for follow-up care.

[1]  S. Gardiner,et al.  Frequency of testing for detecting visual field progression , 2002, The British journal of ophthalmology.

[2]  Sue Ziebland,et al.  Analysing qualitative data , 2000, BMJ : British Medical Journal.

[3]  A. Tatham,et al.  The effect of appointment rescheduling on monitoring interval and patient attendance in the glaucoma outpatient clinic , 2012, Eye.

[4]  D. Garway-Heath,et al.  The direction of research into visual disability and quality of life in glaucoma , 2011, BMC ophthalmology.

[5]  J. Sjöstrand,et al.  Development of a health education programme for elderly with age-related macular degeneration: a focus group study. , 1998, Patient education and counseling.

[6]  K Bandeen-Roche,et al.  Characteristics of discrepancies between self-reported visual function and measured reading speed. Salisbury Eye Evaluation Project Team. , 1999, Investigative ophthalmology & visual science.

[7]  C. Glenton,et al.  What about N? A methodological study of sample-size reporting in focus group studies , 2011, BMC medical research methodology.

[8]  S. Kendall,et al.  The Expert Patients Programme: a paradox of patient empowerment and medical dominance. , 2007, Health & social care in the community.

[9]  M. C. Leske,et al.  Natural history of open-angle glaucoma. , 2009, Ophthalmology.

[10]  S. Ward,et al.  A systematic review and economic evaluation of statins for the prevention of coronary events. , 2007, Health technology assessment.

[11]  S. Ziebland,et al.  Analysing qualitative data , 2000, BMJ : British Medical Journal.

[12]  M. Gordijn,et al.  Factors that influence standard automated perimetry test results in glaucoma: test reliability, technician experience, time of day, and season. , 2012, Investigative ophthalmology & visual science.

[13]  Richard A. Russell,et al.  Are practical recommendations practiced? A national multi-centre cross-sectional study on frequency of visual field testing in glaucoma , 2013, British Journal of Ophthalmology.

[14]  S. Gardiner,et al.  Assessment of patient opinions of different clinical tests used in the management of glaucoma. , 2008, Ophthalmology (Rochester, Minn.).

[15]  B. Munoz,et al.  The Salisbury Eye Evaluation Project , 2007 .

[16]  A. Heijl,et al.  Pitfalls of automated perimetry in glaucoma diagnosis. , 1995, Current opinion in ophthalmology.

[17]  J. Cairns,et al.  The clinical effectiveness and cost-effectiveness of screening for open angle glaucoma: a systematic review and economic evaluation. , 2007, Health technology assessment.

[18]  P. Sainsbury,et al.  Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. , 2007, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[19]  D. Garway-Heath,et al.  Intervals between visual field tests when monitoring the glaucomatous patient: wait-and-see approach. , 2012, Investigative ophthalmology & visual science.

[20]  J. Kitzinger,et al.  Qualitative Research: Introducing focus groups , 1995 .

[21]  Cynthia Owsley,et al.  Perceived barriers to care and attitudes about vision and eye care: focus groups with older African Americans and eye care providers. , 2006, Investigative ophthalmology & visual science.

[22]  M. Wall,et al.  Effect of instructions on conventional automated perimetry. , 2000, Investigative ophthalmology & visual science.

[23]  David B Henson,et al.  Monitoring vigilance during perimetry by using pupillography. , 2010, Investigative ophthalmology & visual science.

[24]  R. P. Mills,et al.  Continuous visual field test supervision may not always be necessary. , 1999, Ophthalmology.

[25]  J. Diamond,et al.  Effect of a patient training video on visual field test reliability , 2003, The British journal of ophthalmology.

[26]  Audrey Paulman,et al.  Why We Don’t Come: Patient Perceptions on No-Shows , 2004, The Annals of Family Medicine.

[27]  D. Broadway,et al.  Barriers to adherence with glaucoma medications: a qualitative research study , 2009, Eye.

[28]  S. Hahn,et al.  Doctor-patient communication in glaucoma care: analysis of videotaped encounters in community-based office practice. , 2009, Ophthalmology.

[29]  K. Lorig,et al.  Patient Self-Management: A Key to Effectiveness and Efficiency in Care of Chronic Disease , 2004, Public health reports.

[30]  N Waugh,et al.  A systematic review of rapid diagnostic tests for the detection of tuberculosis infection. , 2007, Health technology assessment.

[31]  Richard A. Russell,et al.  A survey of attitudes of glaucoma subspecialists in England and Wales to visual field test intervals in relation to NICE guidelines , 2013, BMJ Open.

[32]  H. Baker,et al.  Barriers to uptake of eye care services by the Indian population living in Ealing, west London , 2006 .

[33]  Jennifer A Whitty,et al.  Patient-Centered Approaches to Health Care , 2013, Medical care research and review : MCRR.

[34]  J M Wild,et al.  Long‐term follow‐up of baseline learning and fatigue effects in the automated perimetry of glaucoma and ocular hypertensive patients , 1991, Acta ophthalmologica.

[35]  Susana Molina-Castañer,et al.  Terminology and guidelines for glaucoma , 2009 .

[36]  G. Brown,et al.  Difference between ophthalmologists' and patients' perceptions of quality of life associated with age-related macular degeneration. , 2000, Canadian journal of ophthalmology. Journal canadien d'ophtalmologie.

[37]  Kate Lorig,et al.  Patients as partners in managing chronic disease , 2000, BMJ : British Medical Journal.

[38]  M. Jofre-Bonet,et al.  Hospital-based glaucoma clinics: what are the costs to patients? , 2010, Eye.

[39]  J. Francis,et al.  Why do people present late with advanced glaucoma? A qualitative interview study , 2013, British Journal of Ophthalmology.

[40]  F Davidoff,et al.  Important Elements of Outpatient Care: A Comparison of Patients' and Physicians' Opinions , 1996, Annals of Internal Medicine.

[41]  A Heijl,et al.  Practical recommendations for measuring rates of visual field change in glaucoma , 2008, British Journal of Ophthalmology.

[42]  Ian Murdoch,et al.  Learning to live with glaucoma: a qualitative study of diagnosis and the impact of sight loss. , 2002, Social science & medicine.

[43]  A. Beekman,et al.  Chronic medical conditions and mental health in older people: disability and psychosocial resources mediate specific mental health effects , 1997, Psychological Medicine.

[44]  Paul P. Lee,et al.  Patient expectations regarding eye care: focus group results. , 2003, Archives of ophthalmology.