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Gurjeet Jutley, Derek Ho, Bhavini Gohil, Shabnam Khan, Luna Dhir; Paediatric Ophthalmology Referrals: Causes Of Reduced Vision In Children And How Accurate Are Referrals From Family Practitioners?. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6772.
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The main purpose of the study was to evaluate reasons for reduced vision in children below five years of age referred to the paediatric Ophthalmology service at a large teaching hospital in London. The secondary aim was to detect discrepancy between the diagnosis on referral and the final diagnosis made after full clinical assessment.
Retrospective case note review of 105 consecutive patients presenting to our paediatric (age 0-18 years) ophthalmology service. All cases had their vision recorded using age-appropriate techniques, and had full orthoptic and clinical assessment including cycloplegic refraction. Reduced vision was defined as below 0.2 logMAR as per national referral criteria. The causes of reduced vision were analysed and recorded. The diagnoses on initial referral and the final diagnoses were compared for accuracy.
Majority of patients were referred from family practitioners (67%); 17% from hospital physicians, 7.4% from school nurses and 8.6% from health visitors. 68% of children seen were under 7 years of age; 54 % below 5 years and 34% under 3 years old.Out of 57 children (54%) under 5 years, 28 were referred with reduced vision. Family practitioners referred 17 of these; having liaised with optometrists in only 2 cases prior to referral. Vision was reduced to at least 0.2 logMAR in 25 of these referrals due to: simple refractive errors 50%; hypermetropia with astigmatism 17.9%; significant myopia 10.7%; anisometropic amblyopia 7.1%; intermittent exotropia 10.7%; hypermetropia with accommodative esotropia 3.6% Only 4 of the 28 patients had vision acuity documented in the referral letter.There was a large discrepancy between the initial diagnosis and the final diagnosis made in clinic. 13% of diagnoses on referral were correct, 19% were partially correct and 68% were completely incorrect.
Reduced vision in children below 5 years is largely due to refractive errors and strabismus. Intervention at an early stage in life has maximal impact on final visual outcome. We suggest children with reduced vision be screened by community optometrists before being referred onward to our service.There is only 13% corroboration between diagnoses on referral from the community and the final diagnoses made in our paediatric ophthalmology service. We demonstrated a lack of ophthalmic knowledge in the family practitioners in the UK, which suggests re-training in basic ophthalmic examination.
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