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Neil Farbman, Wayne Cornblath; Monocular precautions counseling. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1391.
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It is strongly advised that patients with decreased or no vision in one eye wear spectacles with 3mm polycarbonate lenses and a safety frame at all times to protect the better-seeing eye. It is the responsibility of ophthalmologists and optometrists to counsel patients regarding these precautions. The purpose of this study is to determine how frequently this counseling occurs and is documented, as well as what factors influence whether it occurs.
We conducted a retrospective chart review of patients who underwent enucleation or evisceration at UMHS during a specified period. We reviewed all encounters for each patient, both before and after surgery. Statistical significance was calculated using chi square and Fisher exact tests.
We identified 39 patients and reviewed 342 encounters. Patients met our criteria for monocular or significantly asymmetric visual acuity (≤20/70 in the worse eye, >20/70 in the better eye) at 324 encounters. Monocular precautions counseling was documented at 78 encounters. Ten patients never received counseling at any encounter. Factors that increased the probability of counseling to a statistically significant degree include worse visual acuity, history of enucleation or evisceration (versus asymmetrical visual acuity prior to surgery), being seen by a fellow or resident in addition to an attending physician, specialty being seen (glaucoma and oculoplastics services most likely to document monocular precautions counseling), white race, and encounter occurring after implementation of electronic health records. Sex and laterality of the worse eye were not statistically significant factors. Age was also not statistically significant, although there was a trend toward greater probability of counseling with increasing decade of life (p = 0.14).
Eye care providers frequently fail to counsel patients on monocular precautions (or at least to document this conversation). Whether counseling takes place depends both on provider factors (specialty, level of training, use of electronic health records) and patient factors (visual acuity, history of enucleation or evisceration, race). Failure to counsel monocular patients puts these patients at increased risk of blindness and exposes eye care providers to potential liability should a devastating injury cause significant vision loss in the better eye. Future studies should evaluate whether interventions can increase the rate at which counseling takes place.
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