Visual field testing and glaucoma drug prescribing patterns in Australia

Abstract

Purpose: To examine glaucoma practice patterns in Australia, focusing on visual field test uptake and antiglaucoma drug prescribing by optometrists and ophthalmologists. Design: A serial cross-sectional study was conducted to describe visual field testing charges and compare them to changes in comprehensive eye examination charges, as well as to analyse Pharmaceutical Benefits Scheme (PBS) items for antiglaucoma prescriptions. Methods: The study utilised Medicare Benefits Schedule (MBS) reimbursements for visual field testing from January 2003 to December 2022, along with PBS prescriptions for antiglaucoma drugs by optometrists and ophthalmologists from January 2008 to December 2022. Results: From 2003 to 2022, rates of visual field testing per 100,000 population in Australia showed a consistent increase, except for a decline in 2020 due to COVID-19 lockdowns, particularly in Victoria. Optometry surpassed ophthalmology in conducting visual field tests in 2009. Prescription rates for antiglaucoma medications rose significantly from 2009 to 2022, following their inclusion in the optometric PBS, with prostaglandin analogues being the most prescribed. During the 2020 lockdowns, visual field testing decreased while antiglaucoma prescriptions remained stable. Conclusions: The increase in visual field testing and antiglaucoma drug prescriptions underscores the expanding role of optometrists in glaucoma management in Australia. This rise has not impacted ophthalmology prescriptions, suggesting that the growing scope of optometric practice effectively reaches a broader patient population, especially amid the public health crisis of undiagnosed glaucoma.