title: Quality of referrals to a pediatric ophthalmology practice in South Western Ontario.
abstract: OBJECTIVE
  The purpose of this study is to examine the referrals made to a pediatric ophthalmology practice in south Western Ontario. Timing of initiating a referral for children presenting with esotropia and the management offered prior to referral will be examined to identify room for improvement.
  
  
  METHODS
  Retrospective chart review of 326 children diagnosed with esotropia with an age of onset <5 years. Data collected included the referring doctor (optometrist or physician), age at onset of the disease, age at referral, clinical characteristics of esotropia at presentation, management, and stereopsis outcome.
  
  
  RESULTS
  A total of 326 charts were reviewed; 63.7% were referred by optometrists and 36.2% by physicians. The mean delay in referral for all cases was 24.64 ± 25.5 months for optometrists and 17.82 ± 19.9 months for physicians. Referrals made by an optometrist were significantly more delayed than those made by physicians when tested with the unpaired t-test (p = 0.0136).
  
  
  CONCLUSIONS
  There is a significant delay in referring all subtypes of esotropia. Management offered prior to referral does not seem to be adequate in more than 50% of patients. Pediatric ophthalmologists need to engage a lot more with the local community of referring doctors and optometrists to advocate for improving management prior to the referral as well as suggest the proper timeline for initiating a referral aiming to improve patient's final outcome.
authors.affiliation: Ivey Eye Institute, University of Western Ontario, London, Canada N6A 4V2. inas.makar@lhsc.on.ca
authors.forename: Inas
authors.initials: I
authors.lastname: Makar
authors.forename: Michelle
authors.initials: M
authors.lastname: Kerrin
authors.forename: Kathy
authors.initials: K
authors.lastname: Smith
mesh_terms: D000550:Amblyopia / Q000175:diagnosis*; D002675:Child, Preschool; D003867:Depth Perception / Q000502:physiology*; D004948:Esotropia / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009864:Ontario; D009885:Ophthalmology / Q000592:standards; D009907:Optometry / Q000592:standards; D012017:Referral and Consultation / Q000592:standards*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D000078329:Workforce