June 2020
Volume 61, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2020
A Delphi Consensus study to determine the feasibility of implementing guidelines for refractive management of older patients at risk of falls
Author Affiliations & Notes
  • Kam Chun Ho
    Injury Division, The George Institute for Global Health, Sydney, New South Wales, Australia
    School of Optometry and Vision Science, UNSW Sydney, New South Wales, Australia
  • David B Elliott
    Department of Optometry and Vision Science, University of Bradford, United Kingdom
  • Emily Charlesworth
    Department of Optometry and Vision Science, University of Bradford, United Kingdom
  • Rajendra Gyawali
    School of Optometry and Vision Science, UNSW Sydney, New South Wales, Australia
  • Lisa Keay
    School of Optometry and Vision Science, UNSW Sydney, New South Wales, Australia
    Injury Division, The George Institute for Global Health, Sydney, New South Wales, Australia
  • Footnotes
    Commercial Relationships   Kam Chun Ho, None; David Elliott, None; Emily Charlesworth, None; Rajendra Gyawali, None; Lisa Keay, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2020, Vol.61, 3066. doi:
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    • Get Citation

      Kam Chun Ho, David B Elliott, Emily Charlesworth, Rajendra Gyawali, Lisa Keay; A Delphi Consensus study to determine the feasibility of implementing guidelines for refractive management of older patients at risk of falls. Invest. Ophthalmol. Vis. Sci. 2020;61(7):3066.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Spectacle prescribing has been shown to impact the risk of falls in older adults and changes are often required after cataract surgery. In 2019, Optometry Australia Guidelines for optometrists summarised the literature and made recommendations to optometrists on how to manage older patients to minimise the risk of falls. This study aimed to use the Delphi technique to gain perspectives on the importance and feasibility of implementing the recommendations.

Methods : A two-round Delphi technique was used to refine a list of 28 evidence-based recommendations with a panel of 11 Australian optometrists currently involved in refractive management of patients with cataract. In the first round, they were asked to comment and rate each recommendation for feasibility and importance on a 5-point agreement scale and whether they already follow this recommendation in their practices. In the second round, they were given a summary of round 1 results and asked to re-rate the feasibility and importance for recommendations without consensus from first round (<80% agree feasibility and importance). The barriers to recommendations with high consensus but low uptake were also explored.

Results : Twenty recommendations (71%) reached consensus (≥80% agreement) in the first round. Recommendation with high consensus but low uptake were history taking about risk of falls (36%) and advising to patients to seek home modification via occupational therapists and other professionals (55%). Australian optometrists would instead refer these patients to low vision services. Other barriers included high cost for multiple pairs of spectacles, the need to delegate some tasks to other practice staff and availability of equipment such as progressive additional lenses for demonstration. There was resistance when recommendations were too prescriptive and could not fit all cases.

Conclusions : Overall, practicing optometrists showed a high level of support for the recommendations and made practical recommendations for implementation. There was some areas of low awareness and scope for improvements to practice in order to meet evidence-based recommendations for prescribing spectacles to minimise falls risk. Full adoption of the evidence-based guidelines could be facilitated with the involvement of practice staffs and practical considerations like costs, individual visual needs and circumstances.

This is a 2020 ARVO Annual Meeting abstract.

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