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Angelica Ly, Lisa Nivison-Smith, Michael Yapp, Michael Kalloniatis; Referral pathways for non-urgent macular disease. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5086.
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Management of non-urgent macular disease is challenging with limited literature available to direct primary eye-care practitioners. Centre for Eye Health (CFEH) is an ocular diagnostics and collaborative optometry-ophthalmology referral service that assesses a wide range of non-urgent macular cases. Thus, this study aimed to provide additional evidence relating to shared care referral and management pathways.
This study was a retrospective, clinical study of 1042 records using the list of patients seen for a macular assessment over a three-year period at CFEH. All patients underwent a standardised macular testing protocol conducted by a highly trained optometrist. Subsequent to each attendance, a report was sent electronically to the referring professional. Patient demographic, referral, clinical examination and report data were extracted from the patient management system including 1) patient age and gender, 2) appointment dates, 3) primary reason for referral, 4) history of ophthalmological care, 5) visual acuity, 6) Amsler grid findings, 7) contrast sensitivity, 8) central subfield thickness classification using optical coherence tomography, 8) final diagnosis, 9) CFEH report recommended management plan. Statistically significant differences were determined using a one-way ANOVA, Kruskal Wallis H or Chi-square test. P-values less than 0.05 were considered significant.
We developed a flowchart designed to facilitate the clinical management decisions of primary eye-care practitioners for non-urgent macular cases. Cases were grouped into one of three clinical scenarios based on suitability for: 1) review in primary care, 2) review in intermediate-tier shared care, and 3) ophthalmological referral. The first visit discharge rate back to primary care averaged 24% over three years. Approximately half (54%) of all cases seen were recommended ongoing follow up in intermediate-tier care; the remaining quarter were recommended referral to ophthalmology. Patients recommended ophthalmological care displayed poorer visual acuity (p<0.001), were more likely to have an Amsler grid defect (p<0.001), poor contrast sensitivity (p<0.01), or a history of ophthalmological care (p<0.01).
Despite a present lack of guidelines, review of referred cases allowed stratification and development of proposed referral pathways for primary-care practitioners.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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