Development of a competency framework for optometrists with a specialist interest in glaucoma J Myint 1 , DF Edgar 1 , A Kotecha 1,2 , DP Crabb 1 and JG Lawrenson 1 Abstract Purpose To develop a competency framework, using a modified Delphi methodology, for optometrists with a specialist interest in glaucoma, which would provide a basis for training and accreditation. Methods A modified iterative Delphi technique was used using a 16-member panel consisting almost exclusively of sub-specialist optometrists and ophthalmologists. The first round involved scoring the relevance of a draft series of competencies using a 9-point Likert scale with a free-text option to modify any competency or suggest additional competencies. The revised framework was subjected to a second round of scoring and free-text comment. The Delphi process was followed by a face-to-face structured workshop to debate and agree the final framework. The version of the framework agreed at the workshop was sent out for a 4- month period of external stakeholder validation. Results There was a 100% response to round 1 and an 94% response to round 2. All panel members attended the workshop. The final version of the competency framework was validated by a subsequent stakeholder consultation and contained 19 competencies for the diagnosis of glaucoma and 7 further competencies for monitoring and treatment. Conclusions Application of a consensus methodology consisting of a modified Delphi technique allowed the development of a competency framework for glaucoma specialisation by optometrists. This will help to shape the development of a speciality curriculum and potentially could be adapted for other healthcare professionals. Eye (2010) 24, 1509–1514; doi:10.1038/eye.2010.62; published online 14 May 2010 Keywords: competency-based education; optometry; glaucoma; Delphi technique Introduction The majority of UK glaucoma cases are identified by community optometrists after routine eye examinations. Individuals detected in this way are usually referred into the hospital eye service for formal diagnosis and on-going management. Over the past decade, increasing demand for the care of patients with diagnosed glaucoma and glaucoma suspects has led to the involvement of non-medical healthcare professionals in hospital-based glaucoma services and in community-based settings. 1 The baseline competencies of optometrists and their existing function in glaucoma case finding makes them suitable healthcare professionals to undertake extended functions in the diagnosis and management of the disease. The recently published National Institute for Health and Clinical Excellence (NICE) guideline 2 on the diagnosis and management of chronic open angle glaucoma (COAG) and ocular hypertension (OHT) made recommendations regarding the involvement of non-medical healthcare professionals in the diagnosis of OHT and suspected COAG and the formulation of a management plan. Although NICE recommends that all patients with suspected glaucomatous damage should be referred to a consultant ophthalmologist for consideration of a definitive Received: 25 January 2010 Accepted in revised form: 26 March 2010 Published online: 14 May 2010 1 Department of Optometry and Visual Science, Henry Wellcome Laboratories for Vision Sciences, City University, London, UK 2 NIHR BMRC for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK Correspondence: J Lawrenson, Department of Optometry and Visual Science, Henry Wellcome Laboratories for Vision Sciences, City University, Northampton Square, London EC1V 0HB, UK Tel: þ 44 0207 0404 310; Fax: þ 44 0207 0040 8494. E-mail: j.g.lawrenson@ city.ac.uk Eye (2010) 24, 1509–1514 & 2010 Macmillan Publishers Limited All rights reserved 0950-222X/10 $32.00 www.nature.com/eye CLINICAL STUDY