Abstract
Purpose :
This study assessed the accuracy of urgent wet Age Related Macular Degeneration (wARMD) referrals by community optometrists to hospital based settings in NHS Ayrshire & Arran. The primary objective was to identify factors influencing referral accuracy and reflect on how this could be improved.
Methods :
Patients referred through the rapid access wARMD pathway between March 2023 and June 2023 were identified. The Macular Coordinator's referral register, along with patient notes, referral letters, electronic and paper records, were reviewed. Key parameters studied included symptoms on the referral form, the presence of Optical Coherence Tomography (OCT) accompanying the referral and the outcome following assessment in the hospital eye clinic.
Results :
Of the 111 patients referred with wARMD by the community optometrists, only 52% were confirmed to have wARMD by the hospital eye clinic. All confirmed wARMD patients were eligible for treatment, however 4% declined. OCT scans accompanied 66% of referrals; 56% of those referrals accurately identified wARMD. 34% of referrals did not have an accompanying OCT; 45% of those referrals were subsequently diagnosed by the hospital eye service to have wARMD. 22% of patients referred as wARMD were diagnosed with dry ARMD. 26% of patients referred as wARMD had other macular pathology not related to ARMD.
Conclusions :
This retrospective study reveals challenges and successes in wARMD referrals. The high false positive rate emphasises the importance of ongoing training of the community optometrists in the assessment of macular diseases, especially in the interpretation of OCT scans. Referral quality and accuracy is enhanced by the inclusion of an OCT scan by the referring optometrist. In particular, the absence of an OCT scan was associated with a high false positive rate with only 45% of patients in this group being confirmed to have wARMD by the hospital eye clinic. Enhancing the quality of referrals by ensuring that an OCT scan is included and by ongoing education of the referring community optometrists should help to reduce the number of false positive referrals and hence optimise the use of the hospital eye services.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.