T he overall aim of the NHS R&D Health Technology Assessment (HTA) programme is to ensure that high-quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most efficient way for those who use, manage and work in the NHS. Research is undertaken in those areas where the evidence will lead to the greatest benefits to patients, either through improved patient outcomes or the most efficient use of NHS resources.The Standing Group on Health Technology advises on national priorities for health technology assessment. Six advisory panels assist the Standing Group in identifying and prioritising projects. These priorities are then considered by the HTA Commissioning Board supported by the National Coordinating Centre for HTA (NCCHTA).This report is one of a series covering acute care, diagnostics and imaging, methodology, pharmaceuticals, population screening, and primary and community care. It was identified as a priority by the Methodology Panel and funded as project number 93/47/09.The views expressed in this publication are those of the authors and not necessarily those of the Standing Group, the Commissioning Board, the Panel members or the Department of Health. The editors wish to emphasise that funding and publication of this research by the NHS should not be taken as implicit support for the recommendations for policy contained herein. In particular, policy options in the area of screening will, in England, be considered by the National Screening Committee. This Committee, chaired by the Chief Medical Officer, will take into account the views expressed here, further available evidence and other relevant considerations.Reviews in Health Technology Assessment are termed 'systematic' when the account of the search, appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others.

PurposeTo determine whether dizziness and falls rates change due to routine cataract surgery and to determine the influence of spectacle type and refractive factors.MethodsSelf‐reported dizziness and falls were determined in 287 patients (mean age of 76.5 ± 6.3 years, 55% females) before and after routine cataract surgery for the first (81, 28%), second (109, 38%) and both eyes (97, 34%). Dizziness was determined using the short‐form of the Dizziness Handicap Inventory. Six‐month falls rates were determined using self‐reported retrospective data.ResultsThe number of patients with dizziness reduced significantly after cataract surgery (52% vs 38%; χ2 = 19.14, p < 0.001), but the reduction in the number of patients who fell in the 6‐months post surgery was not significant (23% vs 20%; χ2 = 0.87, p = 0.35). Dizziness improved after first eye surgery (49% vs 33%, p = 0.01) and surgery on both eyes (58% vs 35%, p < 0.001), but not after second eye surgery (52% vs 45%, p = 0.68). Multivariate logistic regression analyses found significant links between post‐operative falls and change in spectacle type (increased risk if switched into multifocal spectacles). Post‐operative dizziness was associated with changes in best eye visual acuity and changes in oblique astigmatic correction.ConclusionsDizziness is significantly reduced by first (or both) eye cataract surgery and this is linked with improvements in best eye visual acuity, although changes in oblique astigmatic correction increased dizziness. The lack of improvement in falls rate may be associated with switching into multifocal spectacle wear after surgery.

AimsLevels of false positive referral to ophthalmology departments can be high. This study aimed to evaluate commonality between false positive referrals in order to find the factors which may influence referral accuracy.MethodsIn 2007/08, a sample of 431 new Ophthalmology referrals from the catchment area of Bradford Royal Infirmary were retrospectively analysed.ResultsThe proportion of false positive referrals generated by optometrists decreases with experience at a rate of 6.2% per year since registration (p < 0.0001). Community services which involved further investigation done by the optometrist before directly referring to the hospital were 2.7 times less likely to refer false positively than other referral formats (p = 0.007). Male optometrists were about half as likely to generate a false positive referral than females (OR = 0.51, p = 0.008) and as multiple/corporate practices in the Bradford area employ less experienced and more female staff, independent practices generate about half the number of false positive referrals (OR = 0.52, p = 0.005).ConclusionsClinician experience has the greatest effect on referral accuracy although there is also a significant effect of gender with women tending to refer more false positives. This may be due to a different approach to patient care and possibly a greater sensitivity to litigation. The improved accuracy of community services (which often refer directly after further investigation) supports further growth of these schemes.

Citation information: Davey CJ, Green C & Elliott DB. Assessment of referrals to the hospital eye service by optometrists and GPs in Bradford and Airedale. Ophthalmic Physiol Opt 2011, 31, 23–28. doi: 10.1111/j.1475‐1313.2010.00797.x Abstract Purpose:  To investigate the content of referrals to a hospital eye department and describe differences between referring clinician (optometrist or GP) and referral formats. Methods:  A random sample of 433 new referrals to Bradford Royal Infirmary hospital eye service (HES) during 2007 and 2008 were retrospectively analysed. Results:  Three hundred and eleven referrals (72%) were from optometric practice and 122 (28%) from general practice. Optometric referrals were mainly for cataract and posterior capsular opacification (27%), glaucoma or suspect glaucoma (20%) and diabetic retinopathy (10%). Conclusions:  The proportion of referrals to the hospital eye service from optometrists appears to be increasing (1988: 39%, 1999: 48%, present study 72%). GPs mainly refer patients with anterior segment disorders, particularly lid lesions, based on direct observation and symptoms. Optometrists refer patients with a wide range of ocular diseases and include fundus observations and visual acuity measurements in their referrals. There is a need to inform optometrists of what content is required in a referral to the HES from GOS sight tests, at least for the common referral conditions such as age‐related cataract and suspect open‐angle glaucoma. Referral forms specifically designed for these commonly referred conditions are likely to improve referral quality.

The model for delivery of primary eye care in Europe varies from country to country with differing reliance on ophthalmologists, optometrists and dispensing opticians. Comparative analysis of models has tended to focus on interprofessional working arrangements, training and regulatory issues, rather than on whether a particular model is effective for delivering public health goals for that country. National Health Service (NHS) primary eye care services in the United Kingdom (UK) are predominantly provided under a General Ophthalmic Services (GOS) Contract between the NHS and practice owners (contractors).Over two thirds of sight tests conducted in England, Wales and Northern Ireland and all in Scotland are performed under a GOS contract, however many people entitled to a GOS sight test do not take up their entitlement. The fee paid for sight tests conducted under a GOS contract in England, Wales and Northern Ireland does not cover the full cost of conducting the examination. The shortfall must be made up through profits of sale of optical appliances but this business model can be a deterrent to establishing practices within socio-economically deprived communities, and can also be a barrier to uptake of sight tests, even though many people are entitled to a NHS Optical Voucher towards the cost of spectacles or contact lenses. This paper critiques the GOS Contracts within the UK. We argue that aspects of the way the GOS Contract is implemented are contrary to the public health interest and that different approaches are needed to address eye health inequalities and to reduce preventable sight loss. 3 Key wordsPrimary eye care, optometry, ophthalmology, General Ophthalmic Services Contract, models of care Word count 3,000