title: Effectiveness of UK optometric enhanced eye care services: a realist review of the literature.
abstract: UK demographic and legislative changes combined with increasing burdens on National Health Service manpower and budgets have led to extended roles for community optometrists providing locally-commissioned enhanced optometric services (EOS). This realist review's objectives were to develop programme theories that implicitly or explicitly explain quality outcomes for eye care provided by optometrists via EOS and to test these theories by investigating the effectiveness of services for cataract, glaucoma, and primary eye care.
  
  
  
  The review protocol was published on PROSPERO, and RAMESES publication standards were followed. Programme theories were formulated via scoping literature searches and expert consultation. The searching process involved all relevant electronic databases and grey literature, without restrictions on study design. Data synthesis focussed on questioning the integrity of each theory by considering supportive and refuting evidence from the source literature.
  
  
  
  Good evidence exists for cataract, glaucoma and primary eye care EOS that: with appropriate training, accredited optometrists manage patients commensurate with usual care standards; genuine partnerships can exist between community and hospital providers for cataract and glaucoma EOS; patient satisfaction with all three types of service is high; cost-effectiveness of services is unproven for cataract and primary eye care, while glaucoma EOS cost-effectiveness depends on service type; contextual factors may influence service success.
  
  
  
  The EOS reviewed are clinically effective and provide patient satisfaction but limited data is available on cost-effectiveness.
authors: Division of Optometry and Visual Science, City University London, London, UK.|UCL Institute of Ophthalmology, London, UK.
authors: Helen
authors: H
authors: Baker
authors: UCL Institute of Ophthalmology, London, UK.|Corneo-Plastic Unit, Queen Victoria Hospital, East Grinstead, UK.|Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK.
authors: Gokulan
authors: G
authors: Ratnarajan
authors: Manchester Academic Health Sciences Centre, Manchester Royal Eye Hospital, Manchester, UK.
authors: Robert A
authors: RA
authors: Harper
authors: Division of Optometry and Visual Science, City University London, London, UK.
authors: David F
authors: DF
authors: Edgar
authors: Division of Optometry and Visual Science, City University London, London, UK.
authors: John G
authors: JG
authors: Lawrenson
mesh_terms: D002386:Cataract / Q000175:diagnosis; D003153:Community Health Services / Q000191:economics / Q000458:organization & administration / Q000592:standards; D003362:Cost-Benefit Analysis; D005128:Eye Diseases / Q000175:diagnosis*; D005901:Glaucoma / Q000175:diagnosis; D006801:Humans; D009907:Optometry / Q000191:economics / Q000458:organization & administration / Q000592:standards*; D017060:Patient Satisfaction; D006113:United Kingdom
keywords: commissioning; enhanced optometric services; enhanced service schemes; eye care services; ophthalmic disease; realist review