First Author: H.Saedon UK
Co Author(s): C. Sadhra N. Narendran Y. Yang
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The 2013 Royal College of Ophthalmologists Guidelines on age-related macular degeneration (AMD) state that a patient with suspected wet AMD should be referred to a retinal specialist or fast track macular clinic on the same day and seen ideally within one week of referral and not longer than two weeks. An optometrist suspecting wet AMD does not need to refer the patient back to their general practitioner (GP). The aim of this audit was to determine the length of time from the patient being referred to the time of being seen in the diagnostic AMD clinic.
The Royal Wolverhampton National Health Service Department of Ophthalmology
This was a prospective audit of all referrals to one particular fast track macular clinic at Royal Wolverhampton NHS Trust from August 2016-February 2017. Clinical notes and an electronic clinical web portal were used to obtain all the data collected. Time from referral to being seen in the fast track macular clinic was explored, as were demographics, number of patients requiring fundus fluorescein angiography and eventual diagnosis made.
The total number of patients seen in this particular diagnostic AMD clinic was 98. There were 5 non-attenders. 51 were female, 47 male. Mean age was 77 (range 45-93). 92 were Caucasian, 5 Indian, 1 Chinese. Mean number of days from referral to being seen in clinic was 16 days (range 2-37). This was 11 days using the rapid access referral form and 20 days for patients being referred by the optometrist via GP (p<0.05). 28 patients were referred by Ophthalmologists in hospital eye clinics, 25 were referred by an optometrist using the Wet AMD rapid access referral form, 16 by the optometrist via GP, 10 by the optometrist directly, 7 directly by GP, 6 via Accident and Emergency (A&E), and others. 32 out of 98 patients underwent fundus fluorescein angiography. 29 patients had evidence of wet macular degeneration, 29 patients had dry age related macular degeneration, and there were several other diagnoses including vitelliform dystrophy and vitreomacular traction.
There was an unnecessary delay in referral due to patients being sent to their GP via the optometrist and unnecessary hospital visits due to patients being sent to the A&E department rather than being referred to the relevant clinic. More education is required to increase the use of the Royal College of Ophthalmologists’ standard rapid access referral form. We have recommended arranging local discussions and training between consultant ophthalmologists and optometrists to encourage the use of the standard referral form to prevent unnecessary delays in diagnosis and unnecessary visits to A&E for patients.