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Purpose: In the UK, ophthalmology has the highest number of outpatient appointments within the National Health Service. False‐positive referrals from primary care are one of the main factors contributing to the oversubscription of hospital eye services (HESs). We reviewed the accuracy of referrals originating from primary care optometrists and contributing factors, such as condition type and years since registration. Recent findings: Of the 31 studies included in the review, 22 were retrospective analyses of referrals and appointments at the HES. Eight were prospective studies, and one used online clinical vignettes. Seven assessed the accuracy of referrals for all ocular conditions. The remaining studies focused on glaucoma (n = 11), cataracts (n = 7), emergency conditions (n = 4), neovascular age‐related macular degeneration (n = 1) and paediatric binocular vision (n = 1). The diagnostic agreement for suspected emergency ocular conditions was the lowest, with only 21.1% of referrals considered to require urgent attention in one study. For glaucoma, the first‐visit discharge rate was high (16.7%–48%). Optometrist referral accuracy was overall 18.6% higher than General Medical Practitioners'; however, the two mainly referred different ocular conditions. Female optometrists made more false‐positive referrals than males (p = 0.008). The proportion of false positives decreased by 6.2% per year since registration (p < 0.001). Summary: There was significant variation in referral accuracy across different ocular conditions, partly due to differences when defining accurate referrals. Optometrists working in primary care are generally more limited in their resources than the HES. Thus, choosing the cautious option of referral when they are unsure could be in the patients' best interests. The possible effect of increased use of advanced imaging on referrals requires evaluation. Although interventions such as refinement schemes have been put in place, these vary across regions, and their approaches such as virtual referral triaging may reduce unnecessary HES face‐to‐face appointments and promote communication between primary and secondary care. [ABSTRACT FROM AUTHOR]

Research is the core of evidence‐based practice across all healthcare, in order to ensure optimum patient care. The College of Optometrists is a national standard setting institution for optometric practice in the United Kingdom. However, the standards are only as good as the available evidence, and currently there is little evidence relating directly to optometric practice. The National Institute of Health and Care Research, the General Medical Council and The College of Optometrists, amongst others, have published research strategies describing ambitious plans to expand the scope of healthcare research. The aim of this article is to raise awareness of these government initiatives and consider how they may relate to optometric practice. To improve optometrist research engagement, we need to address the barriers to research and implement strategies to overcome them. There are many opportunities to support research, with different degrees of involvement, from signposting patients to research studies, supporting recruitment or collecting data for a multicentre clinical trial, as well as undertaking an individual research project. Healthcare research is changing and there is scope for more practice‐based research activities in optometry. Research should not be a solo endeavour but a multi‐disciplinary effort. Greater collaborations across all stakeholders, including primary care, secondary care, academia, regulators and industry is needed to make this possible. [ABSTRACT FROM AUTHOR]

Purpose: Currently, there are no UK optometric guidelines regarding the pre and postoperative refractive management of patients undergoing cataract surgery. This study used a Delphi method to gain consensus on best practice. Methods: Eighteen recommendations targeted areas of concern/variability in advice that were highlighted in an earlier focus group study of refractive management for patients who had received cataract surgery. These covered three topics: preoperative target refraction discussions, postoperative refractive management and driving advice postoperatively. The recommendations were then developed using evidence from optometry and ophthalmology clinical expertise and the research literature. Eighteen recommendations underwent a process of agreement and modification using a Delphi study consisting of a panel of 22 highly experienced optometrists (N = 11, 25 years mean clinical experience) and ophthalmologists (N = 11, 17 years mean clinical experience) who rated and commented upon the importance and feasibility of each recommendation. The responses were considered by the research team and the recommendations modified and/or removed prior to a second Delphi round of responses to a modified series of recommendations. Consensus of opinion was defined as greater than 80% of panellists 'agreed' or 'strongly agreed' on the recommendation for both importance and feasibility. Results: Fourteen of the 18 recommendations reached consensus in the first round. A second round of the Delphi method saw 17 modified recommendations scored and commented upon by 20 clinicians. Fifteen recommendations reached consensus after two rounds of the Delphi method. Conclusions: Recommendations to guide the pre and postoperative refractive management of patients undergoing cataract surgery were agreed between highly experienced optometrists and ophthalmologists using a 2‐round Delphi method. Patients would benefit from consistent target refraction discussions, postoperative refractive management and driving advice, and recommendations were of particular benefit to less experienced optometrists. [ABSTRACT FROM AUTHOR]

Background: Selective laser trabeculoplasty (SLT), a National Institute for Care and Health Excellence recommended first-line treatment for open-angle glaucoma and ocular hypertension, is increasingly delivered by optometrists. This retrospective multicentre observational study evaluates real-world outcomes of SLT comparing optometrist-treated to ophthalmologist-treated eyes., Methods: Adults aged ≥40 years receiving first SLT treatment at three UK hospital eye units (Aintree, Manchester, Macclesfield) between 1 August 2018 and 1 August 2021 were analysed using anonymised local audit data. Outcomes included intraocular pressure (IOP), visual acuity (VA), drop burden, complications including post-SLT IOP spikes, and composite treatment failures including repeat laser or glaucoma surgery, evaluated at 6-monthly intervals up to 24 months. Groups were compared with parametric and non-parametric tests, accounting for intereye correlation, and Kaplan-Meier survival analysis using composite treatment failure endpoints was conducted., Results: 207 eyes (131 patients) were analysed, 84 (56 patients) optometrist-treated eyes compared with 123 ophthalmologist-treated eyes (75 patients). No statistically significant differences (p>0.05) were found in change in VA, IOP or glaucoma drops from pre-SLT baseline between optometrist and ophthalmologist-treated eyes, at all time points. More cataracts were detected in optometrist-treated eyes, however, this did not affect differences in VA or cataract surgery frequency. More optometrist-treated eyes underwent glaucoma surgery, however, ophthalmologist-treated eyes had higher drop burden and chance of composite treatment failure up to month 18., Conclusion: Outcomes of SLT treatment by optometrists and ophthalmologists are comparable up to 24 months post-treatment. Ophthalmologist-treated eyes may have had more aggressive eye-drop treatment, preventing the need for surgery., Competing Interests: Competing interests: RH is an expert witness for the General Optical Council and is a member of the 2022 NICE guideline committee. None of the other authors have competing interests with respect to this study., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Given the increasing prevalence of diabetes and diabetic retinopathy (DR) in the UK, this study evaluates a novel primary care optometry-based DR review service against traditional hospital-based virtual DR clinics., Methods: In the hospital-based virtual DR service, patients attended for data capture (visual acuity, fundus photography, macular OCT scanning) with asynchronous review at a later data by a hospital clinician. In the primary care optometry DR review clinic, patients attended an optometry practice for a face-to-face(F2F) review (with imaging) by an optometrist with additional training in DR. Data from both clinic types were analysed. Metrics included DR grading, management plans, grading concordance between primary care optometrists and consultant ophthalmologists, and the assessment of "ungradable" retinopathy referrals., Results: One thousand seven hundred and sixty patients attended the virtual clinic between January 2021 and September 2023. 954 patients attended the primary care review clinic between August 2022 and September 2023. Grading agreements between primary care optometrists and hospital consultants on those patients referred for consultant opinion were significant with Weighted Kappa scores of 0.61(95% CI 0.52-0.69) for DR grade and 0.69(95% CI 0.56-0.82) for diabetic macular oedema (DMO) status. Additionally, the primary care optometry clinic reported a considerably reduced non-attendance rate of 5%, in contrast to 21% in virtual clinics., Conclusion: The primary care optometry-based DR service emerges as an efficient, safe alternative to hospital services. It offers notable advantages over virtual clinics and addresses a care gap for those unsuitable for virtual consultations. The results highlight the potential of primary care-based models in managing DR., (© 2024. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

Purpose: As the landscape in ophthalmology and related commissioning continues to change, there is a pressing need to re‐evaluate the current scope of practice of hospital optometrists working within secondary care in the UK. We aim to establish if the skills or services delivered by optometrists have changed to meet varying demands, and to better understand what changes in practice may have arisen as a result of COVID‐19. Method: A survey developed from that used in 2015 was disseminated to 129 optometry Hospital Eye Service (HES) leads in September 2020, including questions on department workforce; core services; extended roles; procedures undertaken within extended roles; level of autonomy; arrangements for prescribing; training and accreditation, and service changes in response to COVID‐19. Results: Ninety responses were received (70% response rate) from within England (76%), Scotland (22%) and Northern Ireland (2%). Whole time equivalents within units ranged from 0.4–79.2 (median of 2.5). In comparison to the 2015 survey, there was an increase in the proportion of units delivering extended roles, with glaucoma (88%) remaining the most common extended role, and new areas of practice in uveitis (21%) and vitreoretinal (13%) services. There was increased use of independent prescribing (67%) in comparison to 18% in 2015 and there was an increase in optometrists delivering laser interventions. In response to COVID‐19, optometrists were increasingly delivering telephone consultations and there were new collaborations between primary and secondary care. Conclusions: Optometrists' scope of practice continues to develop in the HES with an increased variety of roles and an apparent increase in the number of units employing optometrists, often working in roles historically performed by medical practitioners. Such changes appear necessary in recovery and transformation within ophthalmology, alongside wider optometry changes arising at the interface of primary and secondary care. [ABSTRACT FROM AUTHOR]

Objectives: A survey was conducted to describe the current status of optometric awareness and involvement regarding post-stroke management as literature suggests that visual impairment often goes undiagnosed and unmanaged in stroke survivors., Materials and Methods: A questionnaire was developed by the researchers, pilot tested by 5 other optometric researchers and 15 optometrists and modified based on the feedback. Practicing optometrists were invited to complete the anonymous online survey through optometric organizations in Canada, Hong Kong, India, UK, and US., Results: Results showed that the majority of optometrists (61%) see 1-5 post-stroke patients per month, although 15% report seeing none. In all cases, optometrists referred stroke patients to other health care professionals more often than receiving incoming referrals from them. About 21% of all respondents were already fully involved in post-stroke vision care and 57% were interested in being more involved. Limiting factors to seeing more post-stroke patients included resources (29.8%), funding (25.8%), awareness (25.1%), and interest (9.8%). There was consensus among respondents in all countries that optometrists should be members of post-stroke care teams., Conclusion: Optometrists are well suited to provide post-stroke visual rehabilitation but are often not included in care teams for these patients. As a result, the visual management of post-stroke patients often is unaddressed.

Purpose: Optometrists are well positioned to help expand low vision (LV) services and improve their availability and accessibility. Determinants of participation in LV service provision must be well understood to facilitate successful service expansion. This survey aimed to investigate optometrists' professional confidence in the delivery of LV services and attitudes towards further learning., Methods: An online survey was emailed to a sample of College of Optometrists members. Respondents rated their confidence in different areas of core optometric practice; confidence in LV was compared with confidence in other areas. Respondents also rated their confidence in undertaking multiple tasks involved in LV service delivery and in routine optometric practice; confidence was compared between optometrists who do and do not work in a LV service. Attitudes towards learning more about assessing and supporting patients with a vision impairment (VI) were recorded., Results: The survey received 451 recorded responses (15.1% response rate). Optometrists who do not work in a LV service reported significantly lower confidence in LV than in other areas of core optometric practice, whereas optometrists who work in a LV service reported significantly higher confidence in LV than in other areas. Additionally, optometrists who do not work in a LV service reported significantly lower confidence in all tasks involved in LV service delivery than optometrists who work in a LV service (p < 0.001 for all tasks). Approximately 80% of respondents were interested in learning more about assessing and supporting patients with a VI., Conclusions: Optometrists who do not work in a LV service have relatively low confidence in LV, which could contribute to low motivation to participate in LV service provision. There is sizeable interest in learning more about assessing and supporting patients with a VI, which could help to increase motivation to participate in LV service provision., (© 2024 The Authors. Ophthalmic and Physiological Optics published by John Wiley & Sons Ltd on behalf of College of Optometrists.)

Purpose: To investigate the attitudes and understanding of optometrists in the UK and Ireland towards Digital Eye Strain (DES), and to examine related practice patterns. Methods: An anonymous online questionnaire was developed, covering attitude and understanding of DES, examination of patients who may be experiencing DES and approaches to management options. The questionnaire was promoted to UK and Ireland optometrists via professional bodies and local and area optometric committees. Results: 406 responses were included in the analysis. Most respondents agreed that DES was an important concern for optometrists (88.9%). 91.4% reported they felt confident in discussing possible symptoms of DES and management options; this was weakly and negatively associated with number of years qualified (rs = −0.198, p ≤ 0.001). Estimations of the proportion of patients affected by DES were lower than reports in the literature (median 25%, IQR 10%–50%). Most respondents always (60.6%) or frequently (21.9%) inquired about device usage in routine case history taking, and also asked follow‐up questions, although 29.3% only asked about the presence of symptoms half the time or less. Advising on regular breaks (84.0%), lubricants (55.7%) and environment/set up (69.2%) were felt to be extremely or very important by most respondents. Advising on specialist spectacle lenses, specifically blue filtering designs, was considered extremely or very important by 34.2% and 15.2%, respectively. Conclusion: Given the agreement that DES is a significant issue causing frequent and persistent symptoms, and practitioners reported high levels of confidence in discussing DES, patients can expect to receive advice on symptoms and management from their optometrist. Simple management strategies were felt to be most important to advise on, with more uncertainty linked to specialist spectacle lenses. [ABSTRACT FROM AUTHOR]

This study describes the design and application of a range of online clinical vignettes for measuring the impact of Continuing Education and Training (CET) and identifying unwarranted variation in optometric decision-making concerning referrals to secondary care. Twenty computerised vignettes were developed to assess clinical and referral management decisions taken in primary care optometry. The online system was specifically designed to present vignettes (ten pre-CET and ten post-CET) that avoided prompting correct answers. The main study group was qualified optometrists (N = 31) who chose any CET options available to United Kingdom optometrists over six months. Participants submitted a record of the CET undertaken, which was compared with an anonymised General Optical Council (GOC) reference sample. The vignettes were also completed by newly-qualified (N = 18) and pre-registration (N = 11) groups. CET had no significant correlation (p = 0.37) with improvement in optometric clinical decision-making and referral practice (qualified group). Selection bias affected this group who had more CET points (p = 0.008) and peer discussion points (p = 0.003) than the GOC reference sample. Results were indicative due to small sample sizes. Newly-qualified practitioners were significantly more likely to refer than the qualified group (p = 0.004). Number of referrals decreased with time since qualification (p = 0.006). Computerised vignettes are a useful tool for comparing referral decisions between groups. Recruiting clinicians for time-consuming vignette studies is challenging. Strategies to reduce unwarranted variation in optometry, including support for newly-qualified optometrists, require further investigation. [ABSTRACT FROM AUTHOR]

Artificial Intelligence (AI) chatbots are able to explain complex concepts using plain language. The aim of this study was to assess the accuracy of three AI chatbots answering common questions related to contact lens (CL) wear. Three open access AI chatbots were compared: Perplexity, Open Assistant and ChatGPT 3.5. Ten general CL questions were asked to all AI chatbots on the same day in two different countries, with the questions asked in Spanish from Spain and in English from the U.K. Two independent optometrists with experience working in each country assessed the accuracy of the answers provided. Also, the AI chatbots' responses were assessed if their outputs showed any bias towards (or against) any eye care professional (ECP). The answers obtained by the same AI chatbots were different in Spain and the U.K. Also, statistically significant differences were found between the AI chatbots for accuracy. In the U.K., ChatGPT 3.5 was the most and Open Assistant least accurate (p < 0.01). In Spain, Perplexity and ChatGPT were statistically more accurate than Open Assistant (p < 0.01). All the AI chatbots presented bias, except ChatGPT 3.5 in Spain. AI chatbots do not always consider local CL legislation, and their accuracy seems to be dependent on the language used to interact with them. Hence, at this time, although some AI chatbots might be a good source of information for general CL related questions, they cannot replace an ECP. [ABSTRACT FROM AUTHOR]

Purpose: In late 2019, a new coronavirus capable of infecting humans, SARS‐CoV‐2, was identified in Wuhan, China. The resultant respiratory disease was subsequently named COVID‐19. In March 2020, in response to the COVID‐19 pandemic, primary care optometry practices only remained open to deliver essential or emergency eye care. This study aimed to characterise the experiences of United Kingdom (UK)‐based primary care optometrists during the COVID‐19 pandemic. Methods: An email invitation to participate in an online cross‐sectional survey was sent to 3000 UK‐based, currently practicing members of The College of Optometrists (UK). Responses to the structured questionnaire were analysed using descriptive statistics, including frequencies, means and standard deviations. Frequency analyses were used to evaluate items with multiple responses. Free‐text responses were examined using thematic analyses. Results: After data cleaning, a total of 1250 responses remained. Sixty‐three percent were female, 70% self‐identified as being of white ethnicity and 78% were based in England. During the first national lockdown, over half of all respondents were involved with the provision of remote consultations for emergency/urgent care. The majority felt 'very'/'moderately' comfortable conducting remote consultations, but 66% felt professional liability was increased. Forty percent were involved in the provision of face‐to‐face consultations. Eye‐health and vision‐related problems were the most commonly reported patient issues during both remote and face‐to‐face consultations, while contact‐lens related problems were the least. Thematic analysis of the responses showed several challenges adjusting to the pandemic (e.g., working safely), but also some potential benefits (e.g., increased skills). Conclusions: The findings provide an overview of changes to optometric practice in the UK during the COVID‐19 pandemic. The results may be used to inform the development of professional guidance and facilitate resource allocation for safe and effective eye care during this and any future pandemics. [ABSTRACT FROM AUTHOR]

Purpose: Whilst the number of independent prescriber (IP) optometrists in the United Kingdom is increasing, there is limited evidence describing the experiences of these individuals. The Theoretical Domains Framework (TDF) provides an evidence‐based approach to understand determinants of behaviour. This conceptual framework can enable mapping to the COM‐B behaviour change model and the wider Behaviour Change Wheel to develop interventions to optimise behaviour‐change and healthcare processes more systematically. The study aimed to use the TDF to identify the factors that influence independent prescribing behaviour, and to map these findings to the COM‐B system to elucidate the relevant intervention functions, in order to identify the support required by optometrist prescribers. Methods: Using a qualitative design, semi‐structured interviews based on the TDF were undertaken with independent prescriber optometrists. Thematic analysis was used to identify themes inductively, which were then deductively mapped to the TDF and linked to the COM‐B. Results: Sixteen participants (9 male, 7 female; median age 45 years, range 28–65 years), based in community (n = 10) and hospital (n = 6) settings, were interviewed. Eleven of the TDF domains were found to influence prescribing behaviour. Findings highlighted the need for good communication with patients (TDF domain: Skills, COM‐B: Capability); confidence (TDF domain: Beliefs about capabilities, COM‐B: Motivation); good networks and relationships with other healthcare professionals, e.g., general practitioners (TDF domain: Social influences, COM‐B: Opportunity; TDF domain: Social/professional role and identity, COM‐B: Motivation); the need for appropriate structure for remuneration (TDF domain: Reinforcement, COM‐B: Motivation; TDF domain: Social/professional role and identity, COM‐B: Motivation) and the provision of professional guidelines (TDF domain: Knowledge, COM‐B: Capability; TDF domain: Environmental context and resources, COM‐B Opportunity). Conclusions: Having identified theory‐derived influencers on prescribing decisions by optometrists, the findings can be used to develop a structured intervention, such as a support package to help optimise prescribing by optometrists, with the ultimate goal of eye care quality improvement. [ABSTRACT FROM AUTHOR]

The United Kingdom (UK) National Health Service (NHS) currently provides sight tests at no cost to patients for all those aged <16 or ≥60. Some 'at-risk' patients and those in receipt of means-tested benefits are eligible for a NHS sight test between the ages of 16 and 60. In the UK, community optometrists typically either work in independent or national chain practices (multiples). The present study aims to explore whether practice type has any association with sight test outcome. As sight tests are essential in detecting early childhood visual problems, we also aim to explore children's first sight tests. Data from 664,480 NHS sight test claims submitted in Essex from April 2015 to September 2016 were analysed using regression analysis. Practice type (multiple, independent) and children's first sight test were examined with respect to socio-economic status (SES, based on index of multiple deprivation rankings), age and sight test outcome. The median age for a first NHS sight test was 6 years old and was clinically independent of SES. Children's first sight tests typically resulted in neither a spectacle prescription being issued nor an onwards referral. Patients that attend multiples are significantly more likely to receive a new prescription, relative to no prescription, compared to a patient attending an independent (p <.001). Inequalities in sight test outcome appear to exist with differing type of practice (independent or multiple). Choice of practice type appears to be influenced by SES. Children have their first sight test at a later age than recommended. [ABSTRACT FROM AUTHOR]

Objective: Implementing teleophthalmology into the optometric referral pathway may ease the current pressures on hospital eye services caused by over-referrals from some optometrists. This study aimed to understand the practical implications of implementing teleophthalmology by analysing lived experiences and perceptions of teleophthalmology in the optometric referral pathway for suspected retinal conditions., Design: Qualitative in-depth interview study SETTING: Fourteen primary care optometry practices and four secondary care hospital eye services from four NHS Foundation Trusts across the UK., Participants: We interviewed 41 participants: patients (17), optometrists (18), and ophthalmologists (6) who were involved in the HERMES study. Through thematic analysis, we collated and present their experiences of implementing teleophthalmology., Results: All participants interviewed were positive towards teleophthalmology as it could enable efficiencies in the referral pathway and improve feedback and communication between patients and healthcare professionals. Concerns included setup costs for optometrists and anxieties from patients about not seeing an ophthalmologist face to face. However, reducing unnecessary visits and increasing the availability of resources and capacity were seen as significant benefits., Conclusions: Overall, we report positive experiences of implementing teleophthalmology into the optometric referral pathway for suspected retinal conditions. Successful implementation will require appropriate investment to set up and integrate new technology and remunerate services, and continued evaluation to ensure timely feedback to patients and between healthcare professionals is received., Trial Registration Number: ISRCTN18106677., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Background/rationale: Emergency services in the UK, including eye casualty units, are under stress because of increasing demand for services. Audit is an effective way to assess the delivery of services and improve them. This study reports on an audit carried out in the emergency eye care (EEC) service at the University Hospitals of Leicester NHS Trust and the impact of recommendations implemented from a previous evaluation. Methodology: Data of all patients attending eye casualty for a week were collected and analysed and compared to a previous evaluation carried out in 2010. The main categories audited included source and mode of referrals, diagnosis, appropriateness of the referral, evidencebased management and attending professionals. Results: Almost three-quarters of patients were self-referrals (walk-ins). Of 306 cases seen, 101 (33%) were considered inappropriate attendances to an emergency department, based on presenting symptoms and onset, and diagnosis. This is an improvement from the 2010 audit. A total of 277 patients (90%) received evidence-based management. Eighty-nine of the 101 inappropriate attendances could potentially have been managed by community optometrists. Discussion: There is an improvement in the inappropriate attendances presenting to the EEC at the Ophthalmology Department at University Hospitals of Leicester NHS Trust. The evolving role of optometrists in EEC to help manage inappropriate referrals is discussed. [ABSTRACT FROM AUTHOR]

Purpose: A vignette study to examine treatment decisions made by UK hospital optometrists in patients with neovascular age‐related macular degeneration (nAMD) and the effect of optometrists' experience on agreement. Methods: Patients with nAMD attending Manchester Royal Eye Hospital, Manchester, UK were identified as potential candidates for the case series of vignettes. The cases were chosen to reflect a varied case‐mix with respect to difficulty as well as ensuring good quality of the images. Each vignette included a history summary consisting of the number of previous injections given and visual acuity measurements at baseline, the previous visit, and the current visit. Images were compiled to show baseline fundus photographs and ocular coherence tomography (OCT) images with the current visit images on which the treatment decision was to be made along with the images from the previous visit. Hospital optometrists were recruited and asked to complete the series of vignettes, deciding if treatment was required at that visit and how confident they felt with that decision. Their responses were compared to the reference standard created by a consensus of consultant ophthalmologists with a sub‐speciality interest in medical retina. Results: Regarding treatment decision for optometrists, the percentage correct value was 75% with the sensitivity being 75.6% (95% CI 70.1–80.3) and the specificity as 75.1% (95% CI 72.1–77.8). No statistically significant difference was found between differing levels of experience. However, there was a significant difference in confidence levels between groups. Potentially sight threatening decisions accounted for 6.4% of the optometrists' decisions, 3.5% were made with a high confidence rating suggesting no discussion with an ophthalmologist was required. Conclusions: Although the optometrists showed modest agreement with the reference standard in a series of cases that have higher than average complexity, the optometrists showed a similar amount of variability within their treatment decisions compared to the reference standard. The optometrists were therefore not inferior in their performance compared to the ophthalmologists and this can be seen as supporting evidence for their extended role within this clinical area. Experience did not have an effect on 'correct' treatment decisions although there was a statistically significant effect on increasing confidence of treatment decision. [ABSTRACT FROM AUTHOR]

Purpose: In recent years, there has been widespread investment in imaging technologies by community optometrists in the UK, most notably optical coherence tomography (OCT). The aim of the current study was to determine the value of OCT in the diagnosis of posterior segment diseases in a representative sample of community optometrists using a clinical vignette methodology. Methods: A group of community optometrists (n = 50) initially completed a standardised training package on OCT interpretation followed by a computer‐based assessment featuring 52 clinical vignettes, containing images of healthy (n = 8) or glaucomatous (n = 18) discs or healthy (n = 8) or diseased (n = 18) fundi. Each vignette featured either a single fundus/disc photographic image, or a combination of a fundus/disc image with the corresponding OCT scan. An expert panel confirmed that the fundus images presented alone and those in combination with OCT data were of a similar level of difficulty and that the cases were typical of those seen in primary care. For each case, the optometrist selected their diagnosis from a pull‐down list and reported their confidence in their decision using a 10‐point Likert scale. Pairwise comparisons of the fundus image alone and fundus image/OCT combination were made for both diagnostic performance and confidence. Results: The mean percentage of correct diagnoses using fundus imaging alone was 62% (95% CI 59–64%) and for the combination of fundus image/OCT was 80% (95% CI 77–82%). The mean false negative rate with fundus alone was 27% reducing to 13% with the OCT combination. Median confidence scores for fundus imaging alone was 8.0 (IQR 7.0–8.0) and 8.3 (IQR 8.0–9.0) for the combination. Improvements in performance and confidence were statistically significant (p < 0.001). Conclusion: The results from this vignette study suggests that OCT improves optometrists' diagnostic performance compared to fundus observation alone. These initial results suggest that OCT provides valuable additional data that could augment case‐finding for glaucoma and retinal disease; however, further research is needed to assess its diagnostic performance in a routine clinical practice setting. [ABSTRACT FROM AUTHOR]

Purpose: To survey a large number of UK‐based optometrists, in a variety of settings, to determine current attitudes relating to the use of cycloplegia and spectacle prescribing in children aged ≤11 years. Methods: One thousand randomly selected members of the College of Optometrists (UK) were invited to complete an electronic questionnaire. The questionnaire was comprised of 42 questions relating to respondent demographics, practitioner use of cycloplegia and attitudes to using cycloplegia to assess childhood refractive error and prescribing spectacles for children aged ≤11 years. Results: Three hundred and eleven practitioners (31%) completed the questionnaire. Practitioners agreed that they are confident carrying out cycloplegic refraction (60%) and instilling cyclopentolate (77%); are not concerned about the time the procedure takes (69%); feel parents are receptive to its use (65%) and are not discouraged by side effects (72%). Most practitioners agreed that they would carry out a cycloplegic refraction in pre‐school children (aged 2–4 years) at their first eye exam (34% vs 27%), but would not carry out a cycloplegic refraction in a child of school age (5–7 years: 25% vs 47%, 8–11 years: 12% vs 45%). More recently qualified practitioners are more likely to be proactive in using cycloplegia (Mann‐Whitney, p = 0.003). Community practitioners prescribed at slightly lower levels of ametropia in non‐strabismic children than those working in a hospital setting both in the present study and in comparison to previously published hospital optometry values, particularly for hyperopia at 1 year of age. Conclusions: This is the first study to report practitioner use of cycloplegia and attitudes to using cycloplegia to assess childhood refractive error and prescribing spectacles for children in a large number of UK‐based optometrists practising in a variety of settings. The majority of practitioners responded in a positive manner to the use of cycloplegia and reported patterns of use which adhere closely to available professional guidance. However, outcomes indicate practitioners may appreciate more comprehensive evidence‐based resources to inform their decision‐making relating to use of cycloplegia in paediatric examination. [ABSTRACT FROM AUTHOR]

Background: Smoking is a risk factor for various eye conditions. Brief smoking cessation interventions have demonstrated effectiveness when delivered by a range of health care professionals. Optometrists are well placed in the community to advise otherwise healthy smokers to quit, yet remain relatively neglected in smoking cessation research and policy. In a national survey, this study investigated self-reported practices of UK optometrists for delivering brief tobacco smoking cessation interventions to patients.Methods: A randomly selected sample of 1200 optometrists out of the 9000 optometrists registered on the UK College of Optometrists database were invited to complete a 40-item, web-based survey assessing: training related to smoking cessation, current practice (ie, the proportion of patients to which components of very brief advice [Ask, Advise, Assist] and other evidence-based smoking cessation behavior change techniques were delivered), and barriers/enablers to intervention delivery.Results: In total, 408 (34%) responses were received. Most (83%) optometrists received no training in practical skills for delivering smoking cessation support. A third (34%) routinely assessed smoking status. Fewer self-reported advising smokers to quit (22%), offering assistance (via referral to dedicated services) (3%), or advice on smoking cessation medications (2%). Perceived barriers included insufficient knowledge/training (81%) and time (65%). Optometrists were more likely to assess and advise on smoking cessation if they practiced in Scotland, χ2(2) = 32.95, p < .001; an independent optometry practice, χ2(1) = 4.27, p = .39; or had received smoking cessation training, χ2(1) = 13.1, p < .001.Conclusions: Substantial gaps exist in UK optometrists' current smoking cessation training and practice. Evidence-based training resources are needed to support the implementation of smoking cessation interventions into routine optometry practice.Implications: Optometrists are well placed in the community to deliver brief advice interventions to a large population of smokers. This survey provides a comprehensive description of current UK optometry practice related to the provision of evidence-based brief tobacco smoking cessation interventions to patients. Although optometrists perceive advising on smoking cessation as part of their role, numerous substantial gaps in current practice and training remain, which need to be addressed through targeted interventions to increase implementation. [ABSTRACT FROM AUTHOR]

In light of the increased roles of optometrists working in primary care in the UK, this research study aimed to gain an insight into perceptions of dry eye disease (DED), knowledge and confidence in diagnosis and management, and satisfaction with currently available treatment options. Links to an online survey were distributed to optometrists across the UK via optometry websites newsletters, conferences, and local optical committee data bases, between October 2021 and July 2022. The anonymous questionnaire contained a variety of question types including multiple choice, likert-type scale, and free text questions. The survey was completed by 131 optometrists, with a broad range of experience, who reported examining 33.3 ± 31.0 dry eye patients per month. Forty-eight percent of respondents were involved in the provision of an extended service. Fluorescein tear breakup time, corneal fluorescein staining, and anterior lid assessment were the most used clinical procedures, both for diagnosis and monitoring purposes. Sixty percent of respondents reported that they believed their patients were satisfied/managed with artificial tear alone, with the availability of a preservative free option being the top consideration, particularly with increasing severity. Of the 18.7% of respondents who held Independent prescriber status, 68% felt this had widened their ability to diagnose and treat DED. This was evidenced by an increase in steroid recommendation for moderate and severe disease. Although dry eye disease was perceived to be an important condition, opinions varied widely regarding knowledge and confidence in diagnosis and management. Involvement in an extended service did not alter patient management. However, an increase in therapeutic management and the employment of a stepwise approach to management has been identified. [ABSTRACT FROM AUTHOR]

Purpose: To investigate variation in optometric referral decision‐making and the influence of experience and continuing education and training (CET). Methods: To gain insight into unwarranted variation in referral activity in the United Kingdom (UK): (1) triage data were audited to investigate source of referral, provisional diagnosis, and outcome; (2) an online system was developed to present two sets of 10 vignettes, designed to avoid prompting answers. Participating optometrists completed 10 pre‐CET vignettes, recording their tests and management decisions. The main group of participants chose whatever CET they wished over a 6‐month period and then completed another 10 post‐CET vignettes. A second group of newly‐qualified optometrists completed the vignettes before and after a CET course intervention, followed by a third group of pre‐registered optometrists with an intervention of 6‐months experience of their pre‐registration year. Results: The audit identified 1951 optometric referrals and 158 optometrists (211 referrals were from general medical practitioners), with 122 of the 158 optometrists making fewer than ten referrals. Two newly‐qualified optometrists generated 12.5% of the total referrals in the audit (N = 2162). Many suspect glaucoma referrals were based on a single suspect measurement resulting in a high discharge rate after community review, as did referrals for certain fundus‐related appearances for which no treatment was indicated. The intervention of gaining CET points appeared to have no significant impact (p = 0.37) on referral decision‐making, although this part of the study was underpowered. Self‐selection bias was confirmed in the main group. When the main group and newly‐qualified practitioners were compared, the number of referrals was negatively associated with time since qualification (p = 0.005). When all 20 referral decisions were compared, all optometrists referring more than 10 vignette patients came from a group of newly‐qualified practitioners up to 2 years post‐qualification. Pre‐registered optometrists generally referred more appropriately than newly‐qualified. Upon qualification, there was a significant increase in the number of sight tests undertaken per day (p = <0.0005). Conclusions: Gaining CET points alone is unlikely to significantly improve referral decision‐making. Mentoring and targeted CET for the newly‐qualified up to 2 years post‐qualification should be considered. Ophthalmology replies to the referring newly‐qualified optometrist are vital for moderating future referrals and developing clinical confidence. [ABSTRACT FROM AUTHOR]

Background Smoking is a risk factor for a number of eye conditions, including age-related macular degeneration, cataracts and thyroid eye disease. Smoking cessation interventions have been shown to be highly cost-effective when delivered by a range of healthcare professionals. Optometrists are well placed to deliver smoking cessation advice to a wide population of otherwise healthy smokers. Yet optometrists remain a relatively neglected healthcare professional group in smoking cessation research and policy. Surveys of UK medical/nursing schools and of optometrists' training internationally demonstrate significant deficits in current curricular coverage regarding smoking cessation. This study aimed to identify the extent of smoking cessation training in UK optometry trainees' undergraduate and pre-registration training. Methods All undergraduate optometry schools in the UK ( n = 9) were invited to participate in a web-based survey of their curricular coverage and assessment related to smoking cessation, and of perceived barriers to delivering smoking cessation training. A content analysis of the College of Optometrists Scheme for Registration Trainee Handbook 2014 was conducted to identify competence indicators related to smoking cessation. Results Nine undergraduate optometry schools (100%) responded to the survey. The majority reported dedicating limited hours (0-3) to teaching smoking cessation, and predominantly focused on teaching the harmful effects of smoking (89%). Only one school provides practical skills training for delivering evidence-based smoking cessation interventions, including very brief advice. The majority of schools (78%) reported that they did not formally examine students on their knowledge or skills for supporting smoking cessation, and rated confidence in their graduates' abilities to deliver smoking cessation interventions as 'poor' (78%). Lack of knowledge amongst staff was identified as the key barrier to teaching about smoking cessation support. The pre-registration competency framework does not include any competence indicators related to providing support for quitting smoking. Conclusions There are substantial gaps in the current curricula of UK optometry training, particularly regarding practical skills for supporting smoking cessation. Increased curricular coverage of these issues is essential to ensure trainee optometrists are adequately trained and competent in supporting patients to quit smoking. [ABSTRACT FROM AUTHOR]

Purpose The role of the optometrist in the Hospital Eye Service ( HES) has undergone significant development in recent years to include extended areas of clinical practice more traditionally undertaken by ophthalmologists, commensurate with a growing demand for increased capacity in ophthalmic services. In this report, we present the findings from a national survey of the scope of practice of optometrists working in the UK HES. Methods A survey was designed to incorporate questions on the provision of core services before seeking detailed information on the scope of practice within extended roles to include: ophthalmic sub-specialist areas where optometrists currently practice; the undertaking of specific procedures within these services; the relative autonomy of practice within these extended roles; and the training and accreditation requirements for working within extended roles. SurveyMonkey was used to disseminate the survey to the head of optometry in 79 HES units throughout the UK. Results Responses were received from 70 of the 79 (89%) survey invitations. A substantial majority of respondents ( N = 67/70, 96%) indicated that optometrists undertook extended roles. Glaucoma is the leading extended role service provided by optometrists (92% of respondents providing extended role services), with roles in macula (71%), medical retina/diabetes (67%), cataract (55%) and corneal services (55%) also being relatively common. A wide variety of clinical procedures or interventions are undertaken as part of these services, which for a small number of optometrists now also includes the undertaking of specific laser procedures. There is evidence for a significant degree of autonomy within these extended roles. The primary mode of training is an 'apprentice' model, incorporating sessions worked under supervision in ophthalmology clinics. Methods of accreditation for optometric participation in extended role services are varied. Conclusions While optometrists working within the UK HES continue to undertake the traditional clinical roles of refraction, clinically necessary contact lenses, and low vision rehabilitation, it is clear that these professionals now undertake a wide range of extended clinical roles, with a transformed scope of practice now incorporating diverse roles traditionally undertaken by medical practitioners. [ABSTRACT FROM AUTHOR]

The article discusses importance of fitness to practise (FTP) policy to General Optical Council's (GOC's) functioning as a regulator of optometric profession and help to promote standards among optometrists and ensure health and safety of the public and maintain confidence in optometric profession.

Purpose: To review the special pharmacology of tetracycline antibiotics as anti-inflammatory drugs for treatment of obstructive Meibomian gland disease (MGD) METHODS: PubMed was used as principal resource for articles, regardless of language, on doxycycline and minocycline with key interests being on their serum and tissue pharmacokinetics and their use in clinical studies as part of management of MGD.Results: With oral dosing of between 50 and 200mg, peak blood levels of these antibiotics have been reported to be predictably dose-dependent at between 1 and 5 microgram/mL, with human tear film levels not being detectable with 100mg dosing of doxycycline but levels of 0.2 microgram/mL with 200mg minocycline. That these two tetracycline antibiotics reach the conjunctiva is indicated by conjunctival pigmentary changes due to photosensitization after very long term use. Based the reported use in a range of clinical studies on MGD, dosing with these two antibiotics for MGD is likely to be useful at relatively low doses (e.g. 100mg for doxycycline or 50mg for minocycline, either at once or twice daily depending on severity at presentation and previous history) continued for 2 to 3 months, with the expected outcome being small-to-substantial decreases in abnormal appearance of the glands (from -4 to -89%) and increases in tear film stability (from 21 to 273%).Conclusions: Oral doxycycline and minocycline have predictable pharmacokinetics and have been reported to improve Meibomian gland dysfunction over a few months of use. [ABSTRACT FROM AUTHOR]

In this article the author discusses the Court of Appeal decision in R v Rose [2017] that redefines the threshold for prosecution for gross negligence manslaughter. The impact on district nurses will be that they are unlikely to face prosecution where a careless error contributed to a patient's death unless there was a serious and obvious risk of death at the time the error was made. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the types of contact lenses fitted by hospital optometrists within the Midlands region of the United Kingdom (UK). A questionnaire was sent to all the lead optometrists of the Midlands Hospital Optometry Group (MHOG). This group includes optometry hospital eye departments within the Midlands region of the UK. The questionnaire requested information of their last ten contact lens fitting appointments. Details of the patient's age, gender, lens type, wearing times, and presenting condition were retrospectively taken from the patients' records using the appointment diary to identify the last ten patients fitted with contact lenses. Details from a total of 109 contact lens fits were collected. This included 45 females and 64 males with a mean age of 39.4 ± 17.4 years. The mean wearing time was 6.3 ± 1.0 days per week and 10.7 ± 5.1 h per day. Sixty-one percent of the contact lenses fitted were for patients with keratoconus and over half of all the contact lenses fitted were corneal rigid gas permeable lenses. This study highlighted that the main reason for fitting contact lenses in hospital contact lens practice is primary corneal ectasia, and mainly keratoconus. Whilst most patients with keratoconus were fitted with corneal rigid gas permeable contact lenses, around 1 in 6 were fitted with soft contact lenses. This study addresses a gap in the literature about contact lenses fitted in UK hospitals and how they differ from community contact lens practice. [ABSTRACT FROM AUTHOR]

Purpose To investigate the impact of a postgraduate training module on optometrists' clinical decision-making in relation to the diagnosis and management of primary open-angle glaucoma. Methods A group of United Kingdom community optometrists ( n = 53) were assessed immediately before and again 3 months after completing a 3-day didactic postgraduate university module on the diagnosis and management of glaucoma. A smaller control cohort ( n = 20), who did not receive the intervention, was recruited and completed the same assessments on two occasions, separated by approximately 3 months. The assessments comprised: knowledge of five key features of the optic disc in glaucoma, performance on a computer program ( Discus) that assessed the ability to differentiate normal from glaucomatous discs and a clinical decision-making exercise using case-based scenarios. Results The scores for the knowledge of important disc features for the intervention cohort significantly increased from a median of 2/5 to 5/5 post-intervention ( p < 0.001). For the control cohort, the difference in median scores between the two tests was not significant. Analysing the performance of the intervention cohort using the Discus program showed no significant improvement in ability to diagnose a glaucomatous disc following the intervention [mean area under the receiver operating characteristic curve pre-intervention = 0.85 (95% CI: 0.76-0.91), post-intervention = 0.84 (95% CI: 0.76-0.91)]. Similarly, there were no statistically significant differences in mean areas under the receiver operating characteristic curve between tests for the control cohort, although both cohorts compared favourably with a previously published Discus data set from a panel of experts in disc analysis (mean area = 0.87). For the clinical decision-making exercise the median test score for the intervention cohort was unchanged pre- and post-intervention. Conclusion The results of the present study suggest that a traditional didactic approach, in isolation, is unlikely to be suited to training optometrists to achieve or develop the clinical competencies required for glaucoma detection and management. Consideration should be given to the development of specialist postgraduate training that is more practice-based, provides opportunities for active learning and includes strategies for feedback and reinforcement. [ABSTRACT FROM AUTHOR]

The article discusses prevalence of cataract in Great Britain and the referral schemes run by Association of Optometrists (AOP) and presents the views of local optical committees (LOC) on the performance of schemes in London, Great Britain and talks about referral forms and cataract information.

The article presents a study which explores the trends in attitudes and habits of optometrists to retinoscopy in Great Britain. The survey was participated by on thousand members of the College of Optometrists and has used the chi-squared automatic interaction detection (CHAID) tree-growing method. The result of the study shows that retinoscopy was used by optomitrists working in independent practice followed by hospital, locum, and training optometrists

The article offers information on the use of bioptic telescopes for people with vision disorders in Great Britain. It says that bioptic telescope is a low-vision optical device which helps visually impaired person to magnify images. It also mentions several experts in ophthalmology that may give prescription for bioptic telescope trial which includes optometrists, peripatetic teacher, and low-vision clinician.

The last decade has seen developments in nonmedical prescribing, with the introduction of prescribing rights for healthcare professionals. In this article, we focus on the education, training and practice of nonmedical prescribers in the UK. There are around 20 000 nurse independent prescribers, 2400 pharmacist supplementary/independent prescribers, several hundred allied health professional supplementary prescribers and almost 100 optometrist supplementary/independent prescribers. Many are active prescribers, managing chronic conditions or acute episodes of infections and minor ailments. Key aims of nonmedical prescribing are as follows: to improve patient care; to increase patient choice in accessing medicines; and to make better use of the skills of health professionals. Education and training are provided by higher education institutions accredited by UK professional bodies/regulators,namely, the Nursing and Midwifery Council, General Pharmaceutical Council, Health Professions Council and General Optical Council. The programme comprises two main components: a university component equivalent to 26 days full-time education and a period of learning in practice of 12 days minimum under the supervision of a designated medical practitioner. Course content focuses on the following factors: consultation, decision making, assessment and review; psychology of prescribing; prescribing in team context; applied therapeutics; evidence-based practice and clinical governance; legal, policy, professional and ethical aspects; and prescribing in the public health context. Nonmedical prescribers must practise within their competence, demonstrating continuing professional development to maintain the quality engendered during training. Despite the substantial progress, there are several issues of strategy, capacity, sustainability and a research evidence base which require attention to fully integrate nonmedical prescribing within healthcare. [ABSTRACT FROM AUTHOR]

Background: Over 50,000 non-medical healthcare professionals across the United Kingdom now have prescribing capabilities. However, there is no evidence available with regards to the extent to which non-medical prescribing (NMP) has been implemented within organisations across a strategic health authority (SHA). The aim of the study was to provide an overview of NMP across one SHA. Methods: NMP leads across one SHA were asked to supply the email addresses of NMPs within their organisation. One thousand five hundred and eighty five NMPs were contacted and invited to complete an on-line descriptive questionnaire survey, 883 (55.7%) participants responded. Data was collected between November 2010 and February 2011. Results: The majority of NMPs were based in primary care and worked in a team of 2 or more. Nurse independent supplementary prescribers were the largest group (590 or 68.6%) compared to community practitioner prescribers (198 or 22.4%), pharmacist independent supplementary prescribers (35 or 4%), and allied health professionals and optometrist independent and/or supplementary prescribers (8 or 0.9%). Nearly all (over 90%) of nurse independent supplementary prescribers prescribed medicines. Approximately a third of pharmacist independent supplementary prescribers, allied health professionals, and community practitioner prescribers did not prescribe. Clinical governance procedures were largely in place, although fewer procedures were reported by community practitioner prescribers. General practice nurses prescribed the most items. Factors affecting prescribing practice were: employer, the level of experience prior to becoming a non-medical prescriber, existence of governance procedures and support for the prescribing role (p<0.001). Conclusion: NMP in this strategic health authority reflects national development of this relatively new role in that the majority of non-medical prescribers were nurses based in primary care, with fewer pharmacist and allied health professional prescribers. This workforce is contributing to medicines management activities in a range of care settings. If non-medical prescibers are to maximise their contribution, robust governance and support from healthcare organisations is essential. The continued use of supplementary prescribing is questionable if maximum efficiency is sought. These are important points that need to be considered by those responsible for developing non-medical prescribing in the United Kingdom and other countries around the world. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To determine the prevalence of ocular allergy in patients attending optometric practices in the UK West Midlands and the impact this has on patients’ daily lives. Method: Patients attending 9 optometric practices in the West Midlands, UK, were surveyed about the occurrence of ocular allergy, the severity of the symptoms and their treatment. Patients self-reporting ocular allergy were invited to complete a more detailed questionnaire. Results: Of the 1904 consecutive patients assessed (mean age 47.7±23.2 years, 55% female), 13% reported an allergy, 8% an ocular allergy, rated as at least mild in 85% of cases. Medication was used by 77% of patients reporting ocular symptomology. Patients with ocular allergy (n =126) completed the detailed questionnaire. Seasonal symptoms occurred for 3.4±1.9 months of the year with a peak in June to July. The most common ‘hayfever’ type symptoms were itchy eyes and a runny nose, and ocular symptoms were itchiness and a desire to rub the eyes. Most had gained medication over the counter (73%) with advice from GPs (53%), pharmacists (41%) or a friend or relative (18%). Only 11% consulted an optometrist. Medication was mainly in the form of antihistamine tablets (71%), eye drops (40%) and nasal spray (40%). Those interested in a specialist ocular allergy service (83%) were willing to pay £15.50 on average. Conclusion: Ocular allergy is relatively common, but treatment is often self-managed, does not appear to totally overcome the discomfort and rarely involves a detailed eye examination. [Copyright &y& Elsevier]

Aim: To determine whether UK optometrists routinely prescribe the subjective refraction result, or whether adjustments are made to aid patient comfort and adaptation. Method: A questionnaire was distributed by post and via the internet to UK optometrists. It incorporated eight case scenarios that included information regarding a patient’s age, symptoms, habitual refractive correction, subjective refraction and any other pertinent clinical information. For each case, they were asked to indicate what refractive correction they would prescribe. Results: A total of 426 questionnaires were completed. In three cases with asymptomatic patients with negligible changes in visual acuity, about 45% of respondents indicated that they would prescribe the subjective refraction result and about 40% would prescribe the habitual correction. In a further case involving a 75 year-old asymptomatic patient, 55% prescribed the habitual correction. In two cases with large cylinder power changes, about 40% of respondents indicated they would partially prescribe the cylinder power. However, there was a large variation in the suggested modification of sphere powers to accompany the partial cylinder changes. Conclusion: A large sample of UK optometrists indicated that they would prescribe the subjective refraction result regardless of patient age, symptoms and difference between habitual correction and subjective refraction. Optometrists who partially prescribe, employ a wide variety of techniques including some that conflict with conventional teaching. [ABSTRACT FROM AUTHOR]

Background: A recent review found standardised patient (SP) methodology to be the gold standard method for evaluating clinical care. We compared the clinical records describing the content of optometric eye examinations with the actual content, as revealed by SPs. Methods: We recruited 111 community optometrists in the South East of the UK who consented to be visited by unannounced actors for an eye examination. The actors received extensive training to enable accurate reporting of the content of the eye examinations, via an audio recording and a checklist completed for each clinical encounter. Each participating optometrist was visited by three standardised patients. Upon completion of the standardised patient visits, copies of the clinical records were requested. Using the SP findings as the gold standard, the information gathered from the clinical record was classified for each quality criterion as true positive (reported by SP and documented on the record card), false negative (reported by SP but not documented on the record card), false positive (not reported by SP but recorded on the record card) and true negative (not reported by SP and not recorded on the record card). Results: Compared to the gold standard, false positives were identified during record abstraction in 4% of cases and false negatives in 18% of cases. For symptoms and history, the proportion of false negatives ranged from 15% to 25% and 3 to 4% for false positives. The proportion of false negatives for tests performed during the eye examinations ranged from 12% to 22% and false positives ranged from 2% to 6%. Optometrists give patients more verbal advice than is indicated in their records (false negatives, 11–19%). Five to 15% of practitioners recorded patient management and advice that was not reported by the SPs. Conclusions: Our findings regarding optometric consultation mirror the findings in other healthcare disciplines: clinical records are an imperfect representation of the content of a clinical consultation. Clinical records are subject to a recording bias leading to both under- and over-estimation of the care provided due to the presence of false negatives and false positives. This study has important implications for clinico-legal cases, where clinical records are a key item of evidence; and our findings indicate that accurate record-keeping should be a priority for optometric continuing education. [ABSTRACT FROM AUTHOR]

Recent changes in UK law have allowed UK-based optometrists to sell and supply fusidic acid viscous eyedrops, providing it is in the course of their professional activity and in an emergency. Alternatively, the optometrist may access fusidic acid viscous eyedrops, for a named patient, using a written order supplied to a pharmacy. This review provides details of the legal background to these changes, examines the common causes of a bacterial conjunctivitis, examines the mechanism of action of this narrow spectrum antibiotic as a bacteriostatic agent, reviews the susceptibility of common ocular isolates of bacteria to the drug and presents details of the expected pharmacokinetics of the viscous eyedrops. From this perspective, a systematic review is provided of the clinical studies which have investigated the use of fusidic acid viscous eyedrops and their outcome. The indicated use is generally for the treatment of bacterial conjunctivitis and/or blepharoconjunctivitis, especially that caused by Staphylococcus, but not Streptococcus or Haemophilus sp. (more likely associated with concurrent nasopharyngeal infections). The usual regimen for use is twice daily for 5–10 days, depending on severity, and can initially be used more intensively (four times per day). It may also be used for the management of corneal and conjunctival abrasions and foreign body injuries, or some cases of chronic blepharitis. [ABSTRACT FROM AUTHOR]

Aim: Systemic hypertension is a silent killer that may have very few warning signs. This study examines detection and management of patients with cardiovascular disease (CVD) by optometrists in the UK. Method: A survey was sent out to 1402 optometrists who practice in the UK to investigate the nature and knowledge of detection of systemic hypertension. Results: The survey response rate was 37%. Optometrists were neutral to slightly positive towards the use of blood pressure (BP) monitors, but not on a routine basis. The most frequently asked question during history and symptoms concerned the patient's prescribed medication for systemic hypertension, and the least was that of specifying the last BP measurement. The additional test most widely used in the examination of the systemic hypertensive patient was direct ophthalmoscopy with red-free filter. Over one-tenth of optometric practices had a BP monitor, with automated devices being the most popular. Patients most likely to have their BP measured were suspect systemic hypertensives. Retinal haemorrhages are the most important finding in influencing an optometrist's referral criteria for suspected systemic hypertension. Conclusion: Although optometrists monitor the retina for signs of damage from systemic hypertension, further education in this important condition is warranted. [ABSTRACT FROM AUTHOR]

In recent years, optometrists have started to work in some clinical roles in hospital medical clinics. This paper outlines the current working practice in a typical glaucoma clinic at Moorfields Eye Hospital NHS Trust and goes on to establish the ability of an optometrist working with a team of ophthalmologists. In this study, 54 patients (n = 108 eyes) were recruited and clinically assessed by an optometrist. Subsequently, a research fellow (i.e. ophthalmologist) assessed the same patients independently. The results were compared in order to determine the accuracy of the optometrist's evaluation and proposed management. This paper considers the costs of employing personnel by reviewing the salaries of optometrists and medical assistants. Although nurses have started to work alongside ophthalmologists, and orthoptists may be considering such work, it is not within the scope of this paper to consider either of these groups. If optometrists are to become an accepted part of a glaucoma clinical team, consideration needs to be given to the training and experience they receive. [ABSTRACT FROM AUTHOR]

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.

Purpose: To determine whether UK optometrists and ophthalmologists provide target refraction advice to patients prior to cataract surgery, and when this should first be discussed., Methods: Optometrists and ophthalmologists were asked to complete a survey of two clinical vignettes (both older patients with cataract; a pre-operative myope who routinely read without glasses and a patient using a monovision approach), plus multiple choice and short answer questions either using hard copy or online., Results: Responses were obtained from 437 optometrists and 50 ophthalmologists. Optometrists who reported they would provide target refraction advice were more experienced (median 22 years) than those who would leave this to the Hospital Eye Service (median 10 years). The former group reported it was in the patients' best interest to make an informed decision as they had seen many myopic patients who read uncorrected pre-operatively, and were unhappy that they could no longer do so after surgery. Inexperienced optometrists reported that they did not want to overstep their authority and left the decision to the ophthalmologist. The ophthalmologists estimated their percentage of emmetropic target refractions over the last year to have been 90%., Conclusion: Currently, some long-term myopes become dissatisfied after cataract surgery due to an emmetropic target refraction that leaves them unable to read without glasses as they did prior to surgery. Although experienced optometrists are aware of this and attempt to discuss this issue with patients, less experienced optometrists tend not to. This suggests that target refraction needs greater exposure in university training and continuing professional development. To provide patients with the knowledge to make informed decisions regarding their surgery, we suggest an agreed protocol within funded direct referral schemes of initial target refraction discussions by optometrists to introduce the idea of refractive outcomes and outline options, with further discussion with the ophthalmologist to clarify understanding., (© 2022 The Authors. Ophthalmic and Physiological Optics published by John Wiley & Sons Ltd on behalf of College of Optometrists.)

This article gives the optometric analysis of visually impaired infants and young children. Blind registration statistics in Great Britain identify the incidence of newly certified visual impairment in children under 16 years of age. It is difficult to classify childhood visual impairment as it can be arranged according to the site of the primary or secondary lesion or according to the age of the child at the onset of the condition. In dealing with children with visual impairment, the optometrist's ultimate objective must be to obtain the visual status of the child, to provide information on how to utilise optimal vision and to advice on the appropriate use of corrective spectacles.

This article reports on a range of primary care based services started in 1995 by Camden & Islington Health Authority of Great Britain. This work has been characterised by a collaborative ethos that recognised the necessity of the whole of the ophthalmic fraternity-optometrists. Collaboration is now integral to government policy in the field of primary care. Primary care groups are the vehicle which deliver the policy. Optometry has the opportunity to be involved too, but it will require increased awareness on behalf of the National Health Services about what the profession has to offer. No seminar has yet been arranged for optometrists.

Over recent years the British Government has pursued a policy encouraging the integration of primary and secondary health care. This drive to promote the efficient delivery of primary care at local centres has seen the forging of co-operative alliances between various healthcare practitioners. A notable development has been the growth of optometric practice-based schemes for monitoring the eyecare of diabetic patients. This paper reports on the first twelve months operation (April 1995-March 1996, inclusive) of such a 'collaborative care' scheme operating in the Kettering Health Area of Northamptonshire. With the co-operation of their general medical practitioner (GMP) and under the case-review of the hospital-based specialist, diabetic patients attended participating optometric practices for an annual sight test and eye examination including mandatory fundus assessment under mydriasis. A brief 'ticked menu' report was subsequently forwarded to the patient's GMP for filing or action as necessary. A copy was also sent to the hospital clinic to enable updating of the diabetic patient database and for the authorisation of the supplementary fee payable to the examining optometrist. An audit of the first year of operation has indicated that those 92% of optometrists in the locality who participated in the programme logged 34% of the projected diabetic population of the Kettering Health Area. Of these individuals, 10.8% were identified as requiring referral for ophthalmological assessment including 0.7% who needed urgent intervention. Approximately 80% of the referrals were assessed in the Ophthalmology Clinic within the twelve month timeframe of this first year audit: one-third of these patients received treatment and/or a second review over this period, the net outcome being that one-half of the original referrals were returned to the programmer for continued routine annual screening. [ABSTRACT FROM AUTHOR]