Referral Patterns for Pediatric Eye Care within the Public Sector of Barbados

Abstract

Purpose : Utilizing this unique opportunity to evaluate the majority of all children who seek eye care in Barbados, this study aims to determine the origin of referrals and age at first presentation to pediatric eye care centers in the public sector.

Methods : A retrospective, cross-sectional chart review of all patients under 18 years who sought eye care between Jan 1^st and Dec 31^st, 2019 at the two public eye care clinics in Barbados: Winston Scott Polyclinic, a primary care center (PCC) and Queen Elizabeth Hospital, a tertiary care center (TCC) in Barbados. Records with illegible handwriting or missing notes were excluded. The origin of referrals, age at the first visit to an eye care provider and relevant diagnoses were documented.

Results : Preliminary data was collected from 1,112 charts: 514 from TCC (10 months) and 598 from PCC (3 months). There was a statistically significant difference (p<0.0001) between the mean age of referral to TCC (3.6 ± 3.2 years) and PCC (8 ± 4.6 years) (Figure 1). 43% of the TCC referrals were initiated by interdepartmental referrals; 33% were referred from local polyclinics. School screenings constituted 69.2% of referrals to PCC (Figure 2). Referrals for retinopathy of prematurity (ROP) screening all occur at TCC between the ages of 1 and 7 months, with a mean of 2.2 months.

Conclusions : The pediatric population in Barbados has access to two public eye care centers, one PCC and one TCC. The difference between referral ages to the primary and tertiary care centers may be accounted for by the nature of visits. The TCC tends to see younger patients for conditions that may require immediate intervention (e.g., cataract management or ROP screening/management), while the PCC mainly receives referrals for refractive error assessment initiated by teachers’ observations of students’ behavior (e.g., difficulty seeing the board). The mean age of referral to PCC is 8 years, higher than recommended by the Guidelines for Development of Eye Care Programs and Services in the Caribbean, and the US Preventative Services Task Force, which emphasize the importance of eye screening at an early age. Further investigations should assess whether the later age of screening in Barbados negatively impacts visual outcomes.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

 

Fig.1. Mean age at first visit by referral type (year)

 

Fig.2. Types of referrals