Are optometrists necessary in primary health care centres in Saudi Arabia?

Abstract

Blindness and visual impairment are major global health care problems. A systematic review conducted by Pascolini and Mariotti 1 showed that 285 million people (of all ages) are visually impaired because of uncorrected refractive errors (43%), followed by cataract (33%). Among those 285 million, 39 million are blind and 246 million are partially sighted.1 Approximately 228 million (80%) people worldwide are avoidably visually impaired. 1 In the Eastern Mediterranean Region, the World Health Organization (WHO) estimates that about 5 million (13%) are blind.1 Tabbara 2 estimated that 1.5% of the total population and over 20% of the population older than 60 years of Purpose: To determine the prevalence and visual characteristics of patients seen by optometrists and ophthalmologists in Saudi Arabian public hospitals. This model will demonstrate the efficacy, safety and effectiveness of optometrists as the primary point of contact for eye care in primary health care centres. Methods:A retrospective, analytical, record-based study of patients in 10 hospitals in Saudi Arabia was conducted over a period of 6 months. The hospitals were located in 3 of 14 provinces in Saudi Arabia. The current policy is that ophthalmologists be the first point of contact for patients in all hospitals. Ophthalmologists, optometrists and nurses collected the data using a predesigned data collection sheet (Appendix 1) which was divided into four sections -basic data, ocular information, ocular diagnosis and intervention. The pattern of patient examination in the eye clinics in public hospitals was analysed. Additionally, patients' age, gender, nationality, symptoms, diagnosis and treatment were obtained from their medical records and considered for analysis. Diagnosis and treatment were classified by the scope of practice of optometrists and ophthalmologists: refraction, dispensing, rehabilitation of conditions of the visual system, detection, diagnosis and management of ocular diseases and referral to sub-specialty care were considered as optometric diagnoses. Prescription of medications and surgeries were classified as ophthalmologists' diagnoses.Results: A total of 2601 patient records were reviewed from the pre-selected 10 public hospitals.There are approximately 415 public hospitals in Saudi Arabia. Refractive error was the most prevalent diagnosis; 54.5% of the patients were prescribed spectacles to relieve their symptoms of poor vision at distance and/or near. Around 35% of patients received treatment in the form of medications (20.6%), surgeries (11.4%), contact lenses (0.9%), orthoptics (1.8%) and lowvision devices (0.1%). About 0.6% patients were referred for major investigations such as ultrasonography, computed tomography and magnetic resonance imaging scans. No active intervention or treatment except observation was recommended for 7.7% of patients, and 2.4% of patients were referred to other sub-specialties. Based on the scope of practice and diagnostic criteria, the optometry discipline received the highest number of patient...

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Community ophthalmology clinic utilization and morbidities results from a private primary healthcare center in Saudi Arabia

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