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Community Eye Clinics (CEC) increase accessibility of specialist ophthalmic services in the community, reducing demand for tertiary eye services. This paper aims to evaluate the impact of CEC on first-visit referrals from Hougang Polyclinic (HOU) to Tan Tock Seng Hospital Ophthalmology Specialist Outpatient Clinic (SOC). A retrospective analysis was performed on first-visit referrals from Hougang Polyclinic (HOU) to Tan Tock Seng Hospital Ophthalmology Specialist Outpatient Clinic (SOC) over a similar 3-months period before and after the introduction of CEC in August 2018 (1 January to 31 March in 2018 and 2019, respectively). Data pertaining to patients' presenting complaints, referral reasons, final diagnoses, follow-up plans, and need for ophthalmic intervention were obtained. We included 978 patients in our study. There was a 27.5% reduction in the number of first-visit referrals seen at SOC after the establishment of CEC. Patients were more likely to be referred on to sub-specialty eye clinics (10.8% vs. 12.9%, p= p =.304) and receive more ophthalmic interventions (15% vs. 16.3%, p =.066) than prior to CEC. The CEC provides greater accessibility to eye care within the community. Optometrists are upskilled to manage patients with stable eye conditions, whilst eye specialists can provide timely care to the SOC for patients with more severe eye conditions. [ABSTRACT FROM AUTHOR]

Background/Aims Nonalcoholic fatty liver disease (NAFLD) is a major cause of chronic liver disease worldwide. Type 2 diabetes mellitus (T2DM) is an important risk factor for advanced fibrosis in NALFD and causes higher mortality. NAFLD patients have nonspecific symptoms and previously reported poorer quality of life (QOL). We aim to study the prevalence of NAFLD in T2DM patients and evaluate their QOL. Methods Subjects with T2DM were recruited from a public primary care clinic in Singapore and the Endocrinology Clinic of the Singapore General Hospital from November 30, 2015 to October 19, 2017. Patients with significant alcohol consumption, viral hepatitis or known chronic liver disease were excluded. All subjects underwent transient elastography and completed Chronic Liver Disease Questionnaire (CLDQ). Patients were divided into three groups (on-fatty liver group, fatty liver without advanced fibrosis group, and fatty liver with advanced fibrosis group) based on transient elastography results. Demographics, blood test results and CLDQ scores from three groups were compared. Statistical analysis was performed using IBM SPSS version 22.0. Results A total of 440 T2DM patients were included: 79.3% (349/440) had NAFLD of which 13.5% (47/349) had advanced fibrosis. There were significantly more males, smokers and hypertensive patients in advanced fibrosis group, with higher body mass index, alanine aminotransferase, aspartate aminotransferase levels and lower platelet counts. The average CLDQ score was 5.9 of 7 in all patients. No significant differences were found among three groups in all CLDQ domains. Conclusions Our study demonstrates a high prevalence of NAFLD in T2DM patients. The QOL of NAFLD patients was not significantly different from patients with T2DM alone. Clinicians must be vigilant of the high prevalence of NAFLD in T2DM patients and actively screen for advanced fibrosis, as they are largely asymptomatic. [ABSTRACT FROM AUTHOR]