Non-communication between ophthalmologists and optometrists.
Many patients seen in the British hospital eye service are referred by high-street optometrists; and, if the optometrist is to receive feedback from the ophthalmologist, the patient should consent to disclosure of medical information. On the referral form (revised GOS 18) there is a space for this purpose. We investigated the level of communication by asking optometrists in our hospital catchment area about their use of the GOS 18 form and by examining the medical records of all new patients seen in the eye outpatient department in one month. 79 optometrists (55%) returned the questionnaire. 54 routinely used the GOS 18; and, of these, 10 said they obtained patient consent always, 23 sometimes and 21 never. 158 of 555 sets of medical notes contained an optometrist's referral, 107 of them on the revised GOS 18; and patient consent had been recorded on 17 of these forms. Ophthalmologists responded to the optometrist in 2/17 (12%) cases where consent had been obtained and 15/90 (17%) where it had not. Ophthalmologists could provide much better feedback to optometrists. The GOS 18 form could be used more effectively; and there is no reason why patient consent to disclosure of medical information should not be obtained by ophthalmologists as well as by optometrists. (+info)
The Bristol shared care glaucoma study: outcome at follow up at 2 years.
AIM: To examine the outcome of care for patients with glaucoma followed up by the hospital eye service compared with those followed up by community optometrists. METHODS: A randomised study with patients allocated to follow up by the hospital eye service or community optometrists was carried out in the former county of Avon in south west England. 403 patients with established or suspected primary open angle glaucoma attending Bristol Eye Hospital and meeting defined inclusion and exclusion criteria were studied. The mean number of missed points on visual field testing in the better eye (using a "better/worse" eye analysis) in each group were measured. The visual field was measured using the Henson semiautomated central field analyser (CFA 3000). Measurements were made by the research team on all patients at baseline before randomisation and again 2 years after randomisation. The mean number of missed points on visual field testing in the worse eye, mean intraocular pressure (mm Hg), and cup disc ratio using a "better/worse" eye analysis in each group at 2 years were also measured. Measurements were made by the research team on all patients at baseline before randomisation and again 2 years after randomisation. An analysis of covariance comparing method of follow up taking into account baseline measurements of outcome variables was carried out. Additional control was considered for age, sex, diagnostic group (glaucoma suspect/established primary open angle glaucoma), and treatment (any/none). RESULTS: From examination of patient notes, 2780 patients with established or suspected glaucoma were identified. Of these, 752 (27.1%) fulfilled the entry criteria. For hospital and community follow up group respectively, mean number of missed points on visual field testing at 2 year follow up for better eye was 7.9 points and 6.8 points; for the worse eye 20.2 points and 18.4 points. Similarly, intraocular pressure was 19.3 mm Hg and 19.3 mm Hg (better eye), and 19.1 mm Hg and 19.0 mm Hg (worse eye); cup disc ratio at 2 year follow up was 0.72 and 0.72 (better eye), and 0.74 and 0.74 for hospital and community follow up group respectively. No significant differences in any of the key visual variables were found between the two groups before or after adjusting for baseline values and age, sex, treatment, and type of glaucoma. CONCLUSIONS: It is feasible to set and run shared care schemes for a proportion of patients with suspected and established glaucoma using community optometrists. After 2 years (a relatively short time in the life of a patient with glaucoma), there were no marked or statistically significant differences in outcome between patients followed up in the hospital eye service or by community optometrists. Decisions to implement such schemes need to be based on careful consideration of the costs of such schemes and local circumstances, including geographical access and the current organisation of glaucoma care within the hospital eye service. (+info)
Standards for vision science libraries. The Association of Vision Science Librarians.
The minimum levels of staffing, services, budget, and technology that should be provided by a library specializing in vision science are presented. The scope and coverage of the collection is described as well. These standards may be used by institutions establishing libraries or by accrediting bodies reviewing existing libraries. (+info)
Reliability of Snellen charts for testing visual acuity for driving: prospective study and postal questionnaire.
OBJECTIVES: To assess the ability of patients with binocular 6/9 or 6/12 vision on the Snellen chart (Snellen acuity) to read a number plate at 20.5 m (the required standard for driving) and to determine how health professionals advise such patients about driving. DESIGN: Prospective study of patients and postal questionnaire to healthcare professionals. SUBJECTS: 50 patients with 6/9 vision and 50 with 6/12 vision and 100 general practitioners, 100 optometrists or opticians, and 100 ophthalmologists. SETTING: Ophthalmology outpatient clinics in Sheffield. MAIN OUTCOME MEASURES: Ability to read a number plate at 20.5 m and health professionals' advice about driving on the basis of visual acuity. RESULTS: 26% of patients with 6/9 vision failed the number plate test, and 34% with 6/12 vision passed it. Of the general practitioners advising patients with 6/9 vision, 76% said the patients could drive, 13% said they should not drive, and 11% were unsure. Of the general practitioners advising patients with 6/12 vision, 21% said the patients could drive, 54% said they should not drive, and 25% were unsure. The level of acuity at which optometrists, opticians, and ophthalmologists would advise drivers against driving ranged from 6/9(-2) (ability to read all except two letters on the 6/9 line of the Snellen chart) to less than 6/18. CONCLUSIONS: Snellen acuity is a poor predictor of an individual's ability to meet the required visual standard for driving. Patients with 6/9 vision or less should be warned that they may fail to meet this standard, but those with 6/12 vision should not be assumed to be below the standard. (+info)
Isolated short-wavelength sensitive cones can mediate a reflex accommodation response.
Both long- and middle-wavelength sensitive cones mediate the reflex accommodation signal but the contribution from the short-wavelength sensitive cones is unknown. A short-wavelength sensitive cone contribution could extend the range of the signed defocus signal from chromatic aberration. The aim was to determine whether isolated short-wavelength sensitive cones mediate reflex accommodation independently of long- and middle-wavelength sensitive cones. Accommodation was monitored continuously (eight subjects) to a sine-wave grating (3 cpd; 0.53 contrast) moving with a sum of sines motion in a Badal optometer. Two illumination conditions were used: a 'blue' condition that isolated short-wavelength sensitive cones, and a 'white' control condition that stimulated all three cone types. Of the eight subjects, two responded equally in the 'white' and 'blue' condition, four gave reduced responses in the 'blue' condition and two failed to respond in both conditions. The mean response in the 'blue' condition was reduced by 50% compared to the 'white' condition. Further analysis indicated that four of the eight subjects gave responses that were considerably greater than noise (S.D.>1.82) when short-wavelength sensitive cones were isolated. Some subjects can accommodate using only S-cones. (+info)
Predicting the refractive outcome after cataract surgery: the comparison of different IOLs and SRK-II v SRK-T.
AIM: To determine any differences between the predictive abilities of the IOL calculation formulas of SRK-II and SRK-T and to compare these using two different IOL types. METHODS: A prospective, consecutive, single surgeon clinical trial was conducted on 400 consecutive patients who received routine, standardised phacoemulsification cataract surgery. 200 had cataract surgery and had the Alcon MZ30BD, a 5.5 mm one piece PMMA IOL, and another 200 cases used the Chiron C11UB, a silicone plate haptic IOL. The data used optimised A-constants. The measures were preoperative axial length and keratometry, IOL implanted, and refractive error at 4-6 weeks postoperatively. RESULTS: There was no significant difference between the predictive abilities of SRK-II or SRK-T. For the Alcon and Chiron lens respectively, prediction errors using SRK-II were <0.5 dioptres in 58% and 70% and for <1.0 dioptres in 84% and 92%. These differences were statistically significant (chi(2), p=0.02). CONCLUSION: There are differences in the predictability of refractive outcomes between intraocular lens styles. (+info)
The assessment and management of strabismus and amblyopia: a national audit.
AIMS: To determine what systems are in place within ophthalmic services for the assessment and management of children suspected of having amblyopia and strabismus. To find out what methods are used for the assessment of these children. METHODS: A questionnaire-based study auditing 288 orthoptic departments in the UK. RESULTS: Responses were received from 75% orthoptic departments. Most hospitals employ more than one system for the assessment of strabismus and amblyopia, which is generally dependent on route of referral. These include 'orthoptic assessment without refraction' (66%), 'combined orthoptist and ophthalmologist assessment' (66%), while 22% have an entirely orthoptist/optometric system. Ophthalmologists are involved in the initial assessment in 145 units (67%), whereas some units involve an ophthalmologist only if response to treatment is poor (15%), or if surgery is required (6%). Fourteen per cent of units reviewed all children, with discharge criteria being based on normal visual acuity (52%), accurate visual acuity (39%) and a normal orthoptic assessment (42%). Seventy-six per cent of units review some children, commonly as a result of family history (55%), parental concern (43%), poor co-operation (30%) and young age (72%). In the absence of squint or amblyopia children are discharged at the first visit, in only 8% of units. There is considerable variation in the tests used to assess visual acuity. LogMAR-based tests (eg EDTRS) are not routinely used in 75% of units. CONCLUSION: Different systems exist for the assessment and management of squint and amblyopia across the country. While much of this variation is to be expected given their possible aetiologies, some could be reduced to produce a more cohesive service. There is also considerable scope for rationalising the tests used to screen infants and children for amblyopia and strabismus. (+info)
Characteristics of eye care practices with managed care contracts.
OBJECTIVES: To describe the variation in practice structure, financial arrangements, and utilization and quality management systems for eye care practices with managed care contracts. STUDY DESIGN: Cross-sectional survey of 88 group and 56 solo eye care practices that contract with 6 health plans affiliated with a national managed care organization. The survey contained modules on practice structure, financial arrangements, utilization management, and quality management. The survey response rate was 85%. RESULTS: Group practices with both ophthalmologists and optometrists were triple the size of ophthalmology-only groups, and 5 times the size of optometry-only groups. Fee-for-service payments were the primary source of group practice revenues, although 60% of groups derived some revenues from capitation payments. Group practices paid their physicians almost exclusively with fee-for-service payments or salary arrangements, with minimal capitation at the individual level. Almost no practices used both capitation and bonuses to compensate providers. Most practices received practice profiles and three fourths were subject to utilization review, which mainly consisted of preauthorization for procedures, tests, or referrals. Nearly all practices used clinical guidelines, protocols, or pathways in managing patients with diabetic retinopathy or glaucoma. Further, nearly all group practices used computerized information systems to assist in delivering care, and most had provider education programs. CONCLUSIONS: Managed care has affected the way eye care providers organize, finance, and deliver healthcare. In general, our findings paint an optimistic picture of eye care practices that contract with managed care organizations. Few practices bear substantial financial risk, and nearly all practices use quality management tools that could help to improve the quality of care. (+info)