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.

Magnitude of astigmatism - A comparison between eyes.

PURPOSE: Astigmatism is a highly prevalent refractive error and while studies typically focus to describe the axis symmetry between eyes, little is known about the refractive symmetry. Therefore, this study determined the astigmatic power symmetry between eyes in a large clinic population. METHODS: A clinical chart review was conducted at three optometric practices in the United States, the United Kingdom and Canada and subjective refraction data from 88,891 patients 14-70 years of age who presented with at least -0.25DC refractive astigmatism in at least one eye were included in the analysis. Data were obtained at these practices between January 2014 and March 2017. The overall distribution (%) and magnitude (DC) of astigmatism was determined and refractive differences between eyes were identified. RESULTS: The mean age of the patients was 42.1 ± 15.9 years and included 51,685 (58%) female and 37,206 (42%) male patients. In this data pool of 177,782 eyes, 10.9% required zero astigmatic correction, while 56.2% had astigmatism of -0.25 to -0.75DC. In total 23.9% of patients presented with astigmatism of at least -0.75DC in only one eye, while the other eye had 0 to -0.50DC. Overall, the difference in astigmatism between eyes was less than -0.75DC for 82.1% of astigmatic patients. For patients who presented with astigmatism of -1.00DC in the right eye, 80.8% of them had an astigmatic prescription of -1.00 ± 0.50DC in the left eye. For an astigmatic prescription of -4.00DC in the right eye, only 40.6% of patients exhibited astigmatism of -4.00DC ± 0.50DC in the left eye. CONCLUSIONS: The majority of patients exhibited a difference in astigmatism between eyes of less than -0.75DC, however the refractive cylinder power symmetry was significantly lower in patients with higher refractive astigmatism.

Spectacle prescriptions review to determine prevalence of ametropia and coverage of frequent replacement soft toric contact lenses.

PURPOSE: To determine the prevalence of ametropia and astigmatism in a clinic population and to estimate the coverage of frequent replacement soft toric lenses. METHODS: A review of patient files was conducted at three clinical sites. Prescription data collected between January 2014 and March 2017 in a patient cohort 14 to 70 years of age inclusive were analyzed to determine prevalence of ametropia and astigmatism. The percent coverage of frequent replacement soft toric contact lenses has further been estimated using different ranges for sphere, cylinder and axis availability. RESULTS: In total 101,973 patients were included in the analysis of which 69.5% were considered myopic, 26.9% hyperopic and 3.5% emmetropic as determined by the eye with the larger absolute value of the spherical equivalent refraction. Astigmatism in at least one eye was found in 87.2% of the population, with 37.0% of the patients exhibiting astigmatism of at least -1.00DC in at least one eye. With-the-rule astigmatism was most prevalent in the 14 to 20 year-olds (53.0%), while against-the-rule astigmatism was most prevalent in the 41 to 70 year-olds (50.7%). For astigmatic eyes with a cylinder of at least -0.75DC (n = 83,540; 41% of all eyes), the coverage with toric soft lenses varied greatly depending on parameter availability and ranged between 30.7% (sphere: Plano to -3.00D, cylinder: up to -1.75DC, axes: 90 ±â€¯10° and 180 ±â€¯10°) and 96.4% (sphere: + 6.00D to -10.00D, cylinders: up to -2.75DC, 18 axes). CONCLUSION: Currently available frequent replacement soft toric contact lenses provide coverage for up to 96.4% of potential patients.

Customer loyalty among daily disposable contact lens wearers.

BACKGROUND: Optometric practices offer contact lenses as cash sale items or as part of monthly payment plans. With the contact lens market becoming increasingly competitive, patients are opting to purchase lenses from supermarkets and Internet suppliers. Monthly payment plans are often implemented to improve loyalty. This study aimed to compare behavioural loyalty between monthly payment plan members and non-members. METHODS: BBR Optometry Ltd offers a monthly payment plan (Eyelife™) to their contact lens wearers. A retrospective audit of 38 Eyelife™ members (mean±SD: 42.7±15.0 years) and 30 non-members (mean±SD: 40.8±16.7 years) was conducted. Revenue and profits generated, service uptake and product sales between the two groups were compared over a fixed period of 18 months. RESULTS: Eyelife™ members generated significantly higher professional fee revenue (P<0.001), £153.96 compared to £83.50, and profits (P<0.001). Eyelife™ members had a higher uptake of eye examinations (P<0.001). The 2 groups demonstrated no significant difference in spectacle sales by volume (P=0.790) or value (P=0.369). There were also no significant differences in contact lens revenue (P=0.337), although Eyelife™ members did receive a discount. The Eyelife™ group incurred higher contact lens costs (P=0.037), due to a greater volume of contact lens purchases, 986 units compared to 582. CONCLUSIONS: Monthly payment plans improve loyalty among contact lens wearers, particularly service uptake and volume of lens purchases. Additionally the greater professional fees generated, render monthly payment plans an attractive business model and practice builder.