18^th European Ophthalmology Congress

Biography

Biography: Samantha Sii

Abstract

Problem: Since the introduction of NICE guidelines 2009¹, the number of glaucoma referrals from the community optometrists to secondary services have increased across the UK, resulting in increase in first visit discharge rates^2-6. SIGN 144 was introduced in March 2016 in Scotland to meet the need for a more refined guideline to reduce unnecessary referrals.This is the first study conducted in a regional eye centre which aims to assess the impact of SIGN 144 on quality of referrals from community optometrists. Methodology: A retrospective case audit of 385 electronic records from (TRAK) of  patients who attended the new glaucoma clinics in Princess Alexander Eye Pavillion(PAEP) was carried out across two major time periods , 1) Oct-Nov 2015, June-July 2016 and 2) Sept-Oct 2016 These periods were selected to enable comparison of before and after SIGN 144. Inclusion criteria:patients from 18 years and above referred to the PAEP glaucoma outpatients clinic for new glaucoma diagnosis. Primary outcome of this study is first visit discharge rate(FVDR). Secondary outcome is the extent of compliance to recommendations by SIGN guidelines.  Results: 233 patients were included in group 1(Pre-SIGN period) and 152 patients were included in group 2 (Post-SIGN period). Our study showed that there is a significant decline in FVDR between the periods.(odds ratio 0.47, p <0.002). 86% of referrals are compliant to SIGN referral criteria while 12.5% still remains non-compliant. Two main reason for non-compliance include no repeatable visual field defects(42%) , and high IOP either not repeated or not according to referral criteria (36.8%). Conclusion & Significance: Patients who were referred after SIGN guidelines have a 47% less chance of being discharged on first visit. Even though compliance to some recommendations in SIGN guidelines have improved, there is still a need to improve adherence to referral criteria based on visual fields and IOP.