title: Collaborative care of non-urgent macular disease: a study of inter-optometric referrals.
abstract: Diseases involving the macula and posterior pole are leading causes of visual impairment and blindness worldwide and may require prompt ophthalmological care. However, access to eye-care and timely patient management may be limited due to inefficient and inappropriate referrals between primary eye-care providers and ophthalmology. Optometrists with a special interest in macular disease may be useful as a community aid to better stratify and recommend best-practice management plans for suitable patients. This study assesses such a notion by appraising the optometric referral patterns of patients with suspected macular disease to an intermediate-tier optometric imaging clinic.
  
  
  
  We performed a retrospective review of patient records and referrals using patients examined at Centre for Eye Health (CFEH) for an initial or follow up macular assessment between the 1/7/2013 and 30/6/2014 (n = 291). The following data were analysed: patient demographic characteristics, primary reason for referral, diagnosed/suspected condition, CFEH diagnosis and recommended management plan.
  
  
  
  The number of referrals stipulating a diagnosis, confirmed after evaluation at CFEH was 121 of 291 (42%). After evaluation at CFEH, the number of cases without a specific diagnosis was approximately halved (reduced from 47% to 23%), while the number of cases with no apparent defect or normal aging changes rose from 1% to 15%. Overall diagnostic congruency for specified macular conditions was high (58-94%); cases were seldom (30/291, 10%) found to have a completely different macular condition. 244 of 291 (84%) patients seen at CFEH were recommended ongoing optometric care: either with the referring optometrist or through recall to CFEH. Referral to an ophthalmologist was recommended in 47 instances (16%).
  
  
  
  More widespread adoption of intermediate-tier optometric eye-care referral pathways in macular disease (following opportunistic primary care screening) has the potential to reduce the number of cases with non-specific diagnoses and to increase those with a diagnosis of normal aging changes or no apparent disease. The majority of cases seen under this intermediate-tier model required ongoing optometric care only and did not require face-to-face consultation with an ophthalmologist.
authors: Centre for Eye Health, Sydney, Australia.|School of Optometry and Vision Science, UNSW Australia, Sydney, Australia.
authors: Angelica
authors: A
authors: Ly
authors: Centre for Eye Health, Sydney, Australia.|School of Optometry and Vision Science, UNSW Australia, Sydney, Australia.
authors: Lisa
authors: L
authors: Nivison-Smith
authors: Centre for Eye Health, Sydney, Australia.|Department of Ophthalmology, Prince of Wales Hospital, Randwick, Australia.
authors: Michael P
authors: MP
authors: Hennessy
authors: Centre for Eye Health, Sydney, Australia. m.kalloniatis@unsw.edu.au.|School of Optometry and Vision Science, UNSW Australia, Sydney, Australia. m.kalloniatis@unsw.edu.au.
authors: Michael
authors: M
authors: Kalloniatis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003266:Continuity of Patient Care; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008266:Macula Lutea; D008297:Male; D008875:Middle Aged; D009907:Optometry / Q000379:methods*; D012017:Referral and Consultation; D012164:Retinal Diseases / Q000628:therapy*; D012189:Retrospective Studies; D055815:Young Adult
keywords: age-related macular degeneration; collaboration; eye-care; macular disease