Sir,

We read with interest the Portsmouth Glaucoma Referral Refinement Scheme findings.1 The scheme does highlight the potential benefits in the current burden of waiting times and costs on the NHS since the introduction of the NICE guidelines. Interestingly, there was no mention of angle closure suspects in this report.

A similar glaucoma referral refinement scheme in our hospital is run by a glaucoma-trained optometrist and has been in place for the last 14 months.

In this clinic, patients have a series of tests similar to the ones described by the authors, but we also document Van Herick test in all patients and the patients with peripheral limbal anterior chamber depth less than 25% corneal thickness are referred to consultant-led clinics for gonioscopy and further evaluation.

A recent audit of our referral refinement clinic over 3 months showed that out of 35 patients seen, 22 were referred to the consultant clinic. This included three cases (13.6%) with narrow angles with Van Herick less than 25% of corneal thickness. Primary angle closure was confirmed in all three of these cases, and they went on to have laser iridotomy.

We would be keen to know if the authors can share their data on angle closure suspects detected in their scheme.