Demand incidence and episode rates of ophthalmic disease in a defined urban population

Assessment of Ophthalmology Teaching and its Impact on the Choice of Future Specialties Among Medical Students of Jazan University

BACKGROUND

Ophthalmology is essential for primary and specialty care physicians, as eye complaints are common, accounting for a sizable proportion of general practice consultations and emergency department visits. Fundamental ophthalmology knowledge is also relevant to other specialty fields. Thus, medical schools must provide effective undergraduate curricula to teach students about salient points, visual examination skills, emergency recognition, and referral indications. The International Council of Ophthalmology (ICO) has set guidelines that medical students should imbibe to become proficient in ophthalmology. However, there have been no recent investigations evaluating undergraduate ophthalmology education at Jazan University's Faculty of Medicine. Therefore, this study aimed to compare the curriculum at Jazan University to the ICO's requirements for undergraduate medical education.

METHODS

An observational cross-sectional study was conducted with both male and female student participants enrolled in an ophthalmology course at Jazan University's Faculty of Medicine. Following IRB approval, the questionnaire was distributed on social media to assess if Jazan University's undergraduate ophthalmology curriculum complies with ICO standards.

RESULTS

The study included a diverse sample of 322 participants, predominantly consisting of female students (n=178, 55.3%). The participants' ages ranged from 22 to 36 years, with the majority falling within the 24-25 year age range (n=173, 53.7%). Regarding academic performance, (n=117, 36.3%) of participants had a GPA of less than 4, while 66 (20.5%) had a GPA between 4.76 and 5.00. Among the respondents, 31 (9.6%) indicated having no exposure to ophthalmology, while 117 (36.3%) felt they had insufficient exposure. A considerable percentage of participants expressed competence in various areas, such as obtaining ocular history (n=113, 35.1%), testing visual acuity (n=201, 62.4%), and examining extraocular motility (n=201, 62.4%). In total, 98 participants (30.4%) expressed an interest in ophthalmology, while the majority (n=224, 69.6%) were not interested.

CONCLUSION

Essential improvements include increasing hands-on clinical experience, small-group learning, exposure across academic years, and early mentorship. Developing competency-based curricula aligned with ICO guidelines could significantly strengthen education. Better training quality and exposure will equip students with the necessary skills, boost confidence, and potentially expand the ophthalmology workforce.

Pattern of eye diseases in adults at the general outpatient clinic of a Tertiary Hospital in Nigeria

Objective

To determine the pattern of eye diseases at the general outpatient department (GOPD) of a Nigerian tertiary hospital.

Materials and Methods

Patients selected by systematic random sampling at the GOPD of a Nigerian tertiary hospital were studied. Information on sociodemographics and ocular complaints were obtained using interviewer-administered questionnaire. Ocular examination included visual acuity measurement and anterior and posterior segments examinations. Data analysis was with Statistical Package for the Social Sciences.

Results

Three hundred and eighty-two patients, comprising 124 (32.5%) males and 258 (67.5%) females, aged between 18 and 86 years, mean 44.8 ± 15.4 years, were studied; 112 (29.3%) had eye diseases but only 88 (78.6%) patients complained of ocular disorder(s). Common complaints were poor vision 53 (60.4%), red eye and grittiness 15 (17.0%) each. Common eye diseases were lens 52 (13.6%) and conjunctiva 46 (12.0%) disorders. Attaining higher education was protective against eye diseases (P < 0.05).

Conclusion

Nearly a third of patients at the GOPD have eye diseases. Therefore, primary eye care should be integrated into the GOPD service with provision of relevant manpower and facilities for care of the ophthalmic patients.

Direct ophthalmoscopy on YouTube: analysis of instructional YouTube videos' content and approach to visualization

Background

Direct ophthalmoscopy is well-suited for video-based instruction, particularly if the videos enable the student to see what the examiner sees when performing direct ophthalmoscopy. We evaluated the pedagogical effectiveness of instructional YouTube videos on direct ophthalmoscopy by evaluating their content and approach to visualization.

Methods

In order to synthesize main themes and points for direct ophthalmoscopy, we formed a broad panel consisting of a medical student, junior and senior physicians, and took into consideration book chapters targeting medical students and physicians in general. We then systematically searched YouTube. Two authors reviewed eligible videos to assess eligibility and extract data on video statistics, content, and approach to visualization. Correlations between video statistics and contents were investigated using two-tailed Spearman’s correlation.

Results

We screened 7,640 videos, of which 27 were found eligible for this study. Overall, a median of 12 out of 18 points (interquartile range: 8–14 key points) were covered; no videos covered all of the 18 points assessed. We found the most difficulties in the approach to visualization of how to approach the patient and how to examine the fundus. Time spent on fundus examination correlated with the number of views per week (Spearman’s ρ=0.53; P=0.029).

Conclusion

Videos may help overcome the pedagogical issues in teaching direct ophthalmoscopy; however, the few available videos on YouTube fail to address this particular issue adequately. There is a need for high-quality videos that include relevant points, provide realistic visualization of the examiner’s view, and give particular emphasis on fundus examination.

Reasons for visits to an emergency center and hemostatic alterations in patients with recurrent spontaneous subconjunctival hemorrhage

PURPOSE

To evaluate causes of visits to the Eye Emergency Department, determine the prevalence of subconjunctival hemorrhage (SCH), and assess the role of hemostatic abnormalities among patients with spontaneous recurrent SCH (SRSCH).

METHODS

In a prospective study conducted over 2 years, hemostatic function was studied in a subgroup of 105 consecutive patients (39 male) with SRSCH free of systemic risk factors and in 53 age- and sex-matched healthy controls (HC) (24 male).

RESULTS

A total of 10,090 patients (mean age 57.2 ± 16.7 years, range 0-94, median 58.4) were evaluated. A total of 39.3% had ocular trauma, 34.9% inflammatory ocular surface disorder, 5.7% floaters, 3.3% visual symptoms of neurologic origin, 1.6% uveitis, 1.5% ocular hypertension, 0.8% retinal tear or detachment, 0.7% retinal vascular disease, and 0.5% other causes. A total of 1.6% of the patients were hospitalized. A total of 11.7% of patients had SCH: in 86.7% it was spontaneous, in 13.3% consequent to trauma or to ocular surface disorders. A total of 105 patients had SRSCH, and the prevalence of hemostatic abnormalities among them was not different from HC. Type I von Willebrand disease was diagnosed in 1 patient with SCH and in none of the HC (χ² = 0.13, p = 0.72).

CONCLUSIONS

Most patients had ocular infection or trauma and were treated on an outpatient basis; SCH was the third cause of access. The large majority of SCH were unprovoked, and the prevalence of hemostatic alterations in patients with SRSCH and no systemic causes was not different from the general population. Hemostatic screening or second level blood clotting tests were of no use in these patients.

Socioeconomic barriers to rhegmatogenous detachment surgery in Brazil

Purpose. To verify access barriers patients with retinal detachment face to arrive at a reference center and to evaluate patients' knowledge about the disease. Methods. Transversal study that applied a questioner to 65 patients of the Clinical Hospital of the University of Sao Paulo with retinal detachment between February and August of 2010. Results. Reasons for not performing the surgery in other services were as follows: 47% were referred because there was not vitreoretinal surgeon at original service; 27% could not afford the surgery, had no health insurance, or had no coverage at health insurance plan for the procedure. Time between the first symptom and the arrival at our service was as follows: 18 patients arrived in up to 7 days; 35 between 8 and 30 days; 8 between 31 and 90 days; 5 in more than 90 days. Reasons for delay were as follows: 70% did not know how serious the pathology was; 56% thought that it had spontaneous cure; 16% did not have money to pay for ophthalmic evaluation, 10% did not know where to go and 24% for other reasons. Conclusion. Educational programs about disease and measures to optimize the referral to specialized services are needed to accelerate the treatment of patients with rhegmatogenous retinal detachment.

Demand incidence of retinal detachment in Brazil

AIM

To evaluate the epidemiological characteristics of retinal detachment in a defined urban population in the Southeast of Brazil.

METHODS

A retrospective study of patients consulted at the Department of Ophthalmology, State University of Campinas, São Paulo, Brazil, with retinal detachment between June 1, 2003 and July 31, 2004. Data were entered into the Statistical Package for the Social Sciences (version 10.0).

RESULTS

There were a total population of 3 389 294 in the 42 cities of Campinas catchment area. A total of 313 patients fitted the inclusion criteria. The overall demand incidence of retinal detachment was 9.2:100,000. The number of males peaked in the 50-79 age group, whereas that of the females peaked in the 60 to 80+ age group. The ages ranged from 4 months to 84 years (mean 49.3). The female-to-male ratio was 1:2.1. Nontraumatic phakic detachments had the highest demand incidence of 7.1:100,000. The demand incidence of nontraumatic aphakic detachments was very low at 0.09:100,000. Almost one third of all patients seeking treatment presented inoperable cases of retinal detachments.

CONCLUSIONS

This is the first study of demand incidence of retinal detachment in Latin Americans. The age-specific demand incidence increases with age. Nontraumatic phakic detachments were the most common type of detachment. The incidence of the traumatic types of detachment was higher in males than that in females. Such data are important to plan and implement vitreoretinal services taking into account the population likely to be served.

[Ocular allergies]

Recent developments indicate that ocular allergy is more than an IgE-mediated allergic conjunctivitis. Ocular allergy is a disease affecting the entire ocular surface including conjunctiva, lids, cornea, lacrimal gland and tear film. Besides an IgE-mediated reaction, a complex chronic inflammation is involved in the pathogenesis of many ocular allergies. According to their pathogenesis and clinical picture, ocular allergies are classified into mild forms, such as seasonal and perennial allergic conjunctivitis as well as giant papillary conjunctivitis, and chronic, potentially blinding forms such as atopic keratoconjunctivitis and vernal keratoconjunctivitis. New therapeutics act on the entire inflammatory process or try to modulate the allergic reaction early and specifically. The association with non-ocular allergic symptoms requires an interdisciplinary approach.

Primary care and ophthalmology in the United Kingdom

The National Health Service is now primary care led. There are different definitions for primary care and in this review they are analysed and related to ophthalmology to produce a working definition for ophthalmic primary care, summarised as the provision of first contact care for all ophthalmic conditions and follow up, preventive, and rehabilitative care of selected ophthalmic conditions, in a variety of settings, by a diverse workforce. The attributes of primary care are first contact, accessibility, continuity, longitudinality, comprehensiveness, coordination, equity, and accountability. The delivery of ophthalmic primary care should be governed by these and evaluated accordingly. The clinical content of primary care consists of the first presentation of disease, the management of minor illness and trauma, the recurrence of disease, the follow up and support of some chronic conditions, and the delivery of preventive health care. Planning for ophthalmic primary care needs to take service requirements of these categories of disease into account. Primary care research is abundant in ophthalmology but needs to be more structured and targeted. Ophthalmic primary care itself is urgently in need of recognition and formal adoption by the profession.

Ethnic differences in the demand incidence of retinal detachments in two districts in the West Midlands

AIM

To evaluate the epidemiological characteristics of rhegmatogenous retinal detachments (RRDs) in two defined populations in the West Midlands of England.

METHODS

A 5-year retrospective study of patients who underwent surgical repair of their RRD between April 1994 and March 1999. Statistical analysis was done by the Statistical Program for Social Sciences (SPSS) version 10.0.

RESULTS

The total demand incidence of RRD was 11.3 and 6.3 per 100,000 in Wolverhampton and Walsall, respectively. The Asian subgroup had a low demand incidence of 4.6 and 2.0 per 100,000 in each area, respectively. In Wolverhampton the highest age-specific demand incidence was in the 70 to 79-year age group at 29.1 per 100,000, whereas in Walsall it was 98.6 per 100,000 in the 85+ age group. Nontraumatic phakic detachments had the highest demand incidence of 9.7 per 100,000, whereas nontraumatic pseudophakic and aphakic R/D were much lower at 1.2 and 0.3 per 100,000, respectively. There was a 1 : 1.5 female-to-male ratio, with a mean age of 57.8 years (95% CI 54.7-61.0) in females and 55.5 years (95% CI 53.1-57.9) for males. A total of 41.6% (142) of patients presented initially to the Wolverhampton Eye Infirmary Accident and Emergency Department (A&E).

CONCLUSION

This is the first UK-based study. The demand incidence in Caucasians is similar to worldwide figures. Asians have a three times lower incidence of retinal detachments. The demand incidence increases with age. Females have a higher mean age than males. Males (89.5%) were more likely to suffer from traumatic detachments. Younger patients were more likely to present to the optometrist initially. Less than half of the patients will present initially to the eye A&E.

Controlling cancer pain in primary care: the prescribing habits and knowledge base of general practitioners

During recent years, the national policy of the United Kingdom has increasingly recognized the central place of general practitioners (GPs) in the care of cancer patients, from screening and early diagnosis through to palliative care and bereavement. There are, however, continuing reports of poor control of pain and other symptoms in the community. To investigate general practitioners' prescribing habits and knowledge of some key pain control issues in advanced cancer, a postal questionnaire surveyed a random sample of 450 East Anglian GPs. The response rate was 73.3%. Most respondents were familiar with the modern management of cancer pain, including the World Health Organization approach, the use of oral opioids, and the management of bone pain. There was less awareness of the drug options available for more uncommon situations, especially the dose conversion of oral morphine to subcutaneous diamorphine and drugs that may be used in syringe drivers. GPs in the UK are familiar with the management of the more common pain control problems. However, it is not appropriate to expect GPs to know the details of management of more unusual cancer pain problems. Specialist clinicians need to make themselves readily available to advise their generalist colleagues. The educational implications for GPs are discussed.

Prospective cohort trial of Euphrasia single-dose eye drops in conjunctivitis

INTRODUCTION

Eye drops made from Euphrasia rostkoviana Hayne have been used in anthroposophical medicine for more than 70 years for the structuring of the fluid organism in the eye, especially in inflammatory and catarrhal conjunctivitis. The aim of this prospective cohort trial was to describe the efficacy and tolerability of these eye drops in a community-based setting. To evaluate these questions, prospective cohort studies are the best method. This enables the investigator to attain real insights as to which treatment administered related to specific results in a specific group of patients.

DESIGN

Prospective, open label, one-armed, multicentered, multinational cohort trial.

SETTING

The trial was carried out in the clinics of 12 experienced anthroposophical general practitioners and ophthalmologists in Germany and Switzerland.

PATIENTS

Patients with inflammatory or catarrhal conjunctivitis, treated with Euphrasia single-dose eye drops were included in the trial.

INTERVENTION

One drop of Euphrasia single-dose eye drops 1-5 times a day was prescribed. The prescription was determined solely by medical therapeutic needs.

OUTCOME MEASURES

Efficacy variables were: redness, swelling, secretion, burning of the conjunctiva, and foreign body sensation. Tolerability variables were: conjunctival reddening, burning of the conjunctiva, foreign body sensation, and veiled vision. All symptoms were given for the right or left eye separately, with degree of severity in relation to baseline after approximately 7 days (+/-3 days; first follow-up examination) and after approximately 14 days (+/-3 days; second follow-up examination). If, after the first follow-up, all symptoms had disappeared, no second follow-up was done.

RESULTS

Sixty-five (65) patients fulfilled the inclusion criteria for the protocol evaluation. A complete recovery was seen in 53 patients (81.5%) and a clear improvement in 11 patients (17.0%). A slight worsening could only be determined in 1 patient in the second week of treatment (1.5%). No serious adverse events were observed during the entire trial. The efficacy and tolerability were evaluated by the patients and doctors as "good" to "very good" in more than 85%.

CONCLUSION

Euphrasia single-dose eye drops can effectively and safely be used for various conjunctival conditions by general practitioners and ophthalmologists. A dosage of one drop three times a day seems to be the general prescribed dosage.

National survey of corneal abrasion treatment

PURPOSE

To survey the different methods used in the management of corneal abrasions (including iatrongenic cases) nationally.

METHOD

A questionnaire survey of all 162 ophthalmic units in the UK was carried out in 1997.

RESULTS

The response rate was 134 of 162 (83%). The majority of units do not have an established policy for the treatment of corneal abrasions. Topical antibiotic alone and antibiotic together with a cycloplegic are the commonest immediate treatments, whilst the most common treatment course is topical antibiotic. Padding and patient follow-up is practised some of the time by most units and all of the time by the remaining minority. Use of a soft bandage contact lens is uncommon. There is no statistically significant difference (p > 0.05) between the policy-holders and non-policy-holders in their use of the various topical regimes, padding and soft bandage contact lens.

CONCLUSION

The traditional trio of topical antibiotic, cycloplegic and padding is still the mainstay of corneal abrasion treatment amongst units nation-wide. However, there is a lack of reproducible scientific evidence to support this treatment. Larger randomised trials looking at the efficacy of the different treatment options are needed.

Direct ophthalmoscopy versus slit lamp biomicroscopy in diagnosis of the acute red eye

The causes of red eye range from trivial to life-threatening, and many general practitioners are uncertain of their ability to diagnose them with the aid of an ophthalmoscope. We tested the hypothesis that, in the assessment of a patient with red eye, a doctor using a slit lamp biomicroscope would not differ in diagnostic accuracy from a doctor using a direct ophthalmoscope. A cross-over study was conducted in 98 patients newly attending an eye casualty department. 71% of diagnoses agreed exactly, and all potentially sight-threatening lesions were either diagnosed correctly or managed appropriately by doctors using an ophthalmoscope. We conclude that the initial diagnosis and management of patients with an acute red eye is not prejudiced by the lack of a slit lamp biomicroscope.

General practitioner registrars' opinions of general practice training in ophthalmology: a questionnaire survey in the northern region

PURPOSE

Approximately 6% of general practitioners have worked in ophthalmology but to our knowledge the relevance of this training has not previously been evaluated.

METHODS

We sent an anonymous questionnaire to all doctors who had held general practitioner registrar (vocational training) posts in ophthalmology in the Northern Region during a 5-year period (1989-1994).

RESULTS

Twenty-six of 48 (54%) questionnaires were returned. Twenty-five of 26 respondents (96%) thought the training was useful, with 22 (91.7%) continuing to use some ophthalmic practical skills and 17 (65.4%) said they had received adequate and relevant clinical exposure. Twenty-one (87.5%) of those in general practice felt that they were more confident with eye problems than their peers and 12 (50%) said their referral patterns differed. Eleven (46%) had provided advice for colleagues. However, 9 (34.6%) commented on the large service commitment and 5 (19%) felt that supervision had been inadequate. Only 9 (34.6%) had received relevant teaching and 18 (69%) thought more was necessary.

CONCLUSION

We conclude that general practitioner registrar posts in ophthalmology are useful and rewarding but that there is scope for improvement.

Communication and compliance in eye casualty

PURPOSE

This study aimed to assess patients' perceptions and priorities when consulting doctors in eye casualty, to assess their satisfaction with eye casualty and to evaluate and improve patients' level of knowledge and understanding of their treatment.

METHODS

A selected consecutive group of 130 patients presenting to eye casualty between 1 July and 15 September 1995 was interviewed by two of the authors prior to collecting their medication. A further group was interviewed again after collecting their medication from the hospital pharmacist. The hospital pharmacist reiterated treatment details when patients collected their medication. Interviews were conducted by means of a questionnaire. There was no inter- or intraobserver variation. Patients' priorities and perceptions were measured as percentages of the group. Patient satisfaction was measured both by a score on a standardised questionnaire and on a visual analogue scale. Patient recall of treatment details was scored as correct or incorrect. The score prior to and after seeing the pharmacist was compared in those patients who were interviewed after collecting their medication.

RESULTS

Among the patients 30.8% considered themselves emergencies, 20.8% were referred and the remainder attended for non-urgent reasons. Eighty-three per cent (83.0%) were wholly satisfied with the consultation. The consultation scored an average of 8.3, SD 1.6, measured on a visual analogue scale of 0-10. When asked the most important aspects of the consultation 54.6% cited treatment, 25.4% reassurance and 20.0% diagnosis. Ninety-six per cent felt that their treatment had been adequately explained; however, 78.3% made errors when reporting their regimen. A significant improvement in patients' level of recall was found after they had received further information from the hospital pharmacist.

CONCLUSIONS

Firstly, this study shows patients' perceptions and priorities when visiting eye casualty. Secondly, it demonstrates that patients are generally satisfied with their eye casualty attendance. Thirdly, many patients depart with poor understanding of their eye treatment regime which is likely to affect compliance. Communication between doctors and patients was enhanced by involvement of the hospital pharmacist. This strategy is applicable not only to an ophthalmic casualty unit but also to a wider range of settings and could provide a service standard for future audit.

A guide for planning community-oriented health care: the health sector resource allocation model

The objective of this study was to demonstrate the value of a planning model for the design and evaluation of community health services. The health status of Washtenaw County, Michigan was modeled. Data were obtained from the Michigan Department of Public Health, Medstat Systems, and the medical literature for 32 diseases or conditions, representing approximately 85% of causes of death and 56% of medical payments (excluding medication costs). An expanded life-table approach was used for 16 age-and sex-matched cohorts exposed to a disease attack rate, access-to-care rate, case fatality rate, morbidity, and costs. Rates can be modified to reflect changes due to treatment, secular trends, or prevention programs. Two alternative delivery methods were considered to show the potential impact of reducing cardiovascular deaths (worksite initiative), or increasing utilization of services (lay health promotion) on county health status and costs over time. Deaths, bed days, and annual medical payments were the main outcome measurements. Cardiovascular and cancer conditions are and will be the primary causes of death in this population. The most important causes of bed days are musculoskeletal conditions, chronic obstructive pulmonary disease, accidents, strokes, and depression. The major health-care payments are for angina pectoris and/or other cardiac conditions, musculoskeletal conditions, accidents, prenatal care, and/or childbirth, and depression. The two alternative scenarios illustrate how reductions in mortality are not necessarily equated with similar improvements in morbidity or costs. This model presents an overview of the current and projected health status of a community. With such a planning tool, a community can better understand the impact of potential prevention or intervention programs, and help design its health-care system within the constraints of available resources.

Investigation of benefits and costs of an ophthalmic outreach clinic in general practice

BACKGROUND

With the advent of general practitioner fundholding, there has been growth in outreach clinics covering many specialties. The benefits and costs of this model of service provision are unclear.

AIM

A pilot study aimed to evaluate an outreach model of ophthalmic care in terms of its impact on general practitioners, their use of secondary ophthalmology services, patients' views, and costs.

METHOD

A prospective study, from April 1992 to March 1993, of the introduction of an ophthalmic outreach service in 17 general practices in London was undertaken. An ophthalmic outreach team, comprising an ophthalmic medical practitioner and an ophthalmic nurse, held clinics in the practices once a month. Referral rates to Edgware General Hospital ophthalmology outpatient department over one year from the study practices were compared with those from 17 control practices. General practitioners' assessments of the scheme and its impact on their knowledge and practice of ophthalmology were sought through a postal survey of all partners and interviews with one partner in each practice. Patient surveys were conducted using self-administered structured questionnaires. A costings exercise compared the outreach model with the conventional hospital ophthalmology outpatient clinic.

RESULTS

Of 1309 patients seen by the outreach team in the study practices, 480 (37%) were referred to the ophthalmology outpatient department. The annual referral rate to this department from control practices was 9.5 per 10,000 registered patients compared with 3.8 per 10,000 registered patients from study practices. A total of 1187 patients were referred to the outpatient department from control practices. An increase in knowledge of ophthalmology was reported by 18 of 47 general practitioners (38%). Nineteen (40%) of 47 general practitioners took advantage of the opportunity for inservice training with the outreach team; they were more likely to change their routine practice for ophthalmic care or referral criteria for patients with cataracts or diabetes than those who did not attend for inservice training. The outreach scheme was popular with patients, for whom ease of access and familiarity of surroundings were major advantages. The cost per patient seen in the outreach clinics (48.09 pounds) was about three times the cost per patient seen in the outpatient department (15.71 pounds).

CONCLUSION

The model of ophthalmic outreach care in this pilot study was popular with patients and general practitioners and appeared to act as an effective filter of demand for care in the hospital setting. However, the educational impact of the scheme was limited. Although the unit costs (per patient) of the outreach scheme compared unfavourably with those of conventional outpatient treatment, potential health gains from this more accessible model of care require further exploration.

Who should see eye casualties?: a comparison of eye care in an accident and emergency department with a dedicated eye casualty

Emergency care for eye complaints is provided both by accident and emergency (A&E) departments as well as by dedicated eye casualty departments. This study examines the role of each type of department and the quality of eye care provided. Significant differences were found between the accident and emergency department and the eye casualty department in the history, examination and management of eye patients. Most notably, there were significant differences in the quality of the assessment in the two institutions. Overall 19% (19/100) of A&E records had an inadequate history, compared with 2% (1/50) for eye casualty records. Fifty-nine per cent (59/100) of A&E records contained a significant examination omission, compared with only 8% (4/50) of eye casualty records. Most of the omissions related to a failure to perform an adequate, yet simple, ocular examination including failure to record visual acuity. In 44% (44-100) of A&E cases visual acuity was not recorded or recorded incorrectly. In comparison acuity omissions in eye casualty were present in only 4% (2/50) of cases.

An analysis of referral routes and diagnostic accuracy in cases of suspected glaucoma

Over a nine-month period two hundred and thirteen referrals to the Department of Ophthalmology of the Leicester Royal Infirmary, England, for suspicion of glaucoma were examined by a single ophthalmologist. Ninety-nine percent of referrals resulted from the findings at an optometric visit. Despite this, less than 32% were confirmed as having glaucoma and less than 23% had ocular hypertension. Twenty-nine percent showed no abnormality. Of those with glaucoma 19% showed advanced field loss in their worse eye. The guidelines relating to referral practices as a result of optometric examinations need to be reviewed and agreed upon by ophthalmologists, optometrists and general practitioners.

Management of ophthalmic disease in general practice

A study was undertaken to investigate the management of ophthalmic conditions in general practice in order to identify areas requiring education and training input. Management of patients with eye disease presenting to 17 Nottingham general practitioners was examined over a 12-month period. Of all patients registered with the participating doctors, 4% presented with eye problems, accounting for 1.5% of all general practice consultations. Children under five years of age had the highest consultation rates, female patients having higher consultation rates than male patients in all age groups. Infective conjunctivitis was responsible for 41% of consultations about eye problems and allergic conjunctivitis for a further 13%; 70% of consultations resulted in a prescription. Corticosteroids were prescribed in 3% of consultations for eye problems; this was considered inappropriate by the study ophthalmologist in over a third of these cases. Patients were referred for further management following 16% of consultations. Thirty nine per cent of referrals to the hospital ophthalmic service were either to an eye casualty department or requested an urgent clinic appointment. While most eye problems are managed solely by general practitioners there is clearly a need for ophthalmic services that can rapidly provide a specialist opinion. However, most eye disease seen in general practice involves the external eye or anterior segment, and the diagnosis may be confidently made using basic ophthalmic history taking and examination skills with non-specialist equipment. The acquisition of these skills should be emphasized at undergraduate level and built upon in later years in postgraduate training.

Pattern of ophthalmological accidents and emergencies presenting to hospitals

STUDY OBJECTIVE

To investigate the numbers and characteristics of patients with ophthalmological accidents and emergencies presenting to hospitals.

DESIGN

Prospective survey over eight weeks.

SETTING

Two general and one ophthalmic accident and emergency departments, two general outpatient departments, and an eye hospital ward consulting room (all in two teaching hospitals) in Newcastle upon Tyne.

MEASUREMENTS AND MAIN RESULTS

Consultation numbers by age, sex, health district of residence, source of referral, diagnosis, and disposal were determined. An average of 37 ophthalmological emergency patients were seen daily. The all cause consultation rate per 1000 population for Newcastle residents was 2.64 (17.2 per year); for injuries it was 1.10 (7.2 per year) and for inflammations the rate was 0.91 (5.9 per year). Consultation rates per 1000 were 3.5 for males and 1.8 for females, the excess being explained by the higher risk of injury to men. Most patients were self-referred (58%), consulted during office hours (79.6%), were attended by senior house officers working alone (83.9%), and were asked to return for follow up (66.1%). Patients in an accident and emergency department seldom saw a consultant in their initial management. The diagnoses of patients from outside Newcastle were little different from those who lived within the city. The 10 commonest problems accounted for 68% of all cases. Injuries were the commonest problem (40.9% of all diagnoses).

CONCLUSION

Ophthalmological accident and emergencies are an important component of an accident and emergency department workload. These patients are usually seen by junior doctors, some untrained in ophthalmology. The wide range of presenting problems poses a challenge for training and the organisation of effective referral chains, while the gender difference in injury rates points to the potential for prevention.