Challenging CAP Assessment Inspires Quality Improvements

January 31, 2022

The Cataract/Refractive Surgery/Glaucoma CAP assessment that was offered last year was the most challenging of the nine assessments that have been developed so far by ABO. It was also the incentive for many ABO Diplomates’ Quality Improvement Activity (QIA). The challenge and the incentive both stemmed from the journal article by Donald C. Hood titled “Improving our understanding, and detection, of glaucomatous damage: An approach based upon optical coherence tomography (OCT).”

The Hood article proved to be difficult reading as it relied heavily on illustrations, which were presented separately from the text, and it was information-dense. Despite these challenges, many Diplomates extracted the crucial points in the article and were motivated to modify their approaches to diagnosing and managing glaucoma patients.

Dr. Ann Allison of Kittanning, PA said that after completing the CAP assessment and attending a CE course on early detection of glaucoma, she was concerned that glaucoma suspects were being under-evaluated. She developed a new EHR template for her practice that includes the GCC scan stats and temporal NFL in addition to VF, gonioscopy, OCT, posterior segment photos, and IOP and medication tracking. These prompts increase the capture rate and documentation of this data by staff and improve efficiency in the follow-up care of high-risk patients.

Dr. Mary DaCanal of Johnsonburg, PA realized after completing the CAP assessment that she wasn’t fully utilizing all the information obtained through OCT and VF testing and decided to re-evaluate how she monitors glaucoma patients. She conducted a chart review of 15 glaucoma patients, comparing the RNFL and macular thickness on OCT to VF test results. This led to the development of a new protocol for reviewing and comparison of test results and to increased confidence in the management of her glaucoma patients.

After completing the CAP assessment, Dr. Reid Grayson of Shelburne, VT has a better understanding of the superior, macular and inferior vulnerability zones; where they lie on the TSNIT; and how glaucomatous damage to these areas correlates with VF test results. This prompted him to add to his battery of glaucoma testing, including GCC, RNFL, and 10-2 VF testing. He now relies more on OCT results and looks more deeply into the VF test results.

Dr. Jeffrey Sutro of Lynnwood, WA said that the article clarified for him the “Hood Glaucoma Report” that is available on his OCT. That report has become his most useful and reliable tool for evaluating glaucoma with the OCT.

Thank you to the Diplomates who’ve allowed us to share their QIAs. By sharing the quality improvement efforts of fellow Diplomates, we hope to inspire others in achieving the ultimate goal of ABO’s board certification program – advancing the quality of eye care for the benefit of all patients.

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