Analysis of UK eye casualty presentations.

CLINICAL RELEVANCE: Optometrists upskilling and participating in enhanced optometric schemes has the potential to improve service accessibility and alleviate pressure on hospital eye services. BACKGROUND: There is a growing demand for eye care in the UK with rising hospital attendances thought to be due in part to an ageing population and a shift in behaviour to favour emergency secondary care. METHODS: Records of first-time presentations to the eye casualty department at the County Hospital (Wye Valley NHS Trust), Hereford, UK, over a month were analysed retrospectively and sequentially. The proportion of patients from optometrist referrals with conditions potentially requiring pharmacological intervention, that could have been retained within community optometry by an independent prescriber, was assessed. For general practitioner and self-referrals, the reasons for visit were compared to the Minor Eye Conditions Service criteria for inclusion. Patient conditions reviewed at the hospital following their initial presentation were grouped according to those who could have been discharged to a commissioned optometric service. RESULTS: The records of 421 patients were organised by the source of referral and condition diagnosed by the hospital practitioner. Thirty-three percent of optometrist referrals could have been managed by an independent prescribing optometrist. Ninety-two percent of patients presenting from general practitioner referrals and 83 percent of self-referrals could have been assessed via the local optometric scheme. Sixty-six percent of patients attending hospital for follow-up could have been seen within the community. CONCLUSION: The present analysis highlights the value of commissioned local optometric community services to address acute ocular symptoms and the value of an independent prescribing qualification in helping to further alleviate the burden on hospital emergency eye services. The large number of self-referrals suggests that the general public needs to be further educated on services that are available at a community optometry level.

Central and peripheral visual performance in myopes: contact lenses versus spectacles.

PURPOSE: Myopia is known to degrade visual performance with both optical and retinal changes implicated. Whether contact lenses or spectacles provide better visual performance for myopes is still under debate. The purpose of this study was to examine central and peripheral visual function in myopic subjects corrected with contact lenses versus spectacles. METHODS: Size thresholds were measured at 13 locations for 20 myopic subjects (mean spherical equivalent refractive error (SE): -6.43±1.22 D and cylinder power: -0.23±0.22 D) corrected with contact lenses (new etafilcon A contact lens, fitted 15 min prior to measurements) versus spectacles. Measurements were taken at both low (δl/l=14%) and high (δl/l=100%) contrast levels. The data were analysed using one way repeated-measures ANOVA. RESULTS: Size thresholds increased with eccentricity in a similar manner for both forms of optical correction. Repeated-measures ANOVA showed no statistically significant difference in central and peripheral visual performance between the two forms of correction for both low and high contrast tasks. The outcome remained the same following correction for spectacle magnification. CONCLUSION: Eye care practitioners can be confident that modern soft contact lenses do not impair visual performance compared to spectacle lenses for the majority of myopes.