Impact of the COVID-19 pandemic and Honey Rose case on hospital attendances of patients suspected to have papilloedema

McNicholl, Catherine; Gill, Arran; Harrison, Rhys; Atan, Denize

doi:10.1038/s41433-022-02310-0

Cited by 3 publications

(4 citation statements)

References 3 publications

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“… 37 An increase in defensive practice has also been noted among optometrists through increased false positive referral rates, 38 including for neuro-ophthalmology, following the high-profile case of undiagnosed papilloedema in an 8-year-old patient in 2016. 39 Davey et al 40 found that false positive referrals generated by optometrists decrease with experience at a rate of 6.2% per year, indicating that newly qualified ECPs take a more conservative approach to management decisions, which is consistent with the findings reported here. While it is understandable that ECPs may wish to practise cautiously, defensive medicine can increase pressure on services that are already struggling, resulting in lower-quality care and an economic impact.…”

Section: Discussionsupporting

confidence: 85%

“…While it is understandable that ECPs may wish to practise cautiously, defensive medicine can increase pressure on services that are already struggling, resulting in lower-quality care and an economic impact. 39 This was supported by the opinions of ophthalmologists who indicated they wanted myopia management to remain within primary eyecare.…”

Section: Discussionmentioning

confidence: 98%

“…Anxiety over misdiagnosis has been reported among other healthcare professions, for example GPs, and may lead to the practice of ‘defensive medicine’, whereby management of a patient is based on fear of litigation, rather than on best practice or patient well-being 37. An increase in defensive practice has also been noted among optometrists through increased false positive referral rates,38 including for neuro-ophthalmology, following the high-profile case of undiagnosed papilloedema in an 8-year-old patient in 2016 39. Davey et al 40 found that false positive referrals generated by optometrists decrease with experience at a rate of 6.2% per year, indicating that newly qualified ECPs take a more conservative approach to management decisions, which is consistent with the findings reported here.…”

Section: Discussionmentioning

confidence: 99%

“…Davey et al 40 found that false positive referrals generated by optometrists decrease with experience at a rate of 6.2% per year, indicating that newly qualified ECPs take a more conservative approach to management decisions, which is consistent with the findings reported here. While it is understandable that ECPs may wish to practise cautiously, defensive medicine can increase pressure on services that are already struggling, resulting in lower-quality care and an economic impact 39. This was supported by the opinions of ophthalmologists who indicated they wanted myopia management to remain within primary eyecare.…”

Section: Discussionmentioning

confidence: 99%

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Eyecare practitioner perspectives and attitudes towards myopia and myopia management in the UK

Coverdale,

Rountree,

Webber

et al. 2024

BMJ Open Ophth

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ObjectiveMany children with progressive myopia are still prescribed single-vision correction. An investigation into UK eyecare practitioners’ (ECPs) perceptions of myopia management was carried out to ascertain factors which may be limiting its implementation and uptake within clinical practice.Methods and analysisOnline focus groups were held with UK ECPs. Participants were encouraged to discuss their knowledge of the available myopia management options, their perception of how myopia management is being delivered in the UK and any barriers limiting ECPs' prescribing of these management options in practice. The discussions were transcribed and analysed thematically.ResultsFocus groups were held with 41 ECPs from primary and secondary eyecare. ECPs felt that provision of myopia management in the UK is variable. Most ECPs believe they have sufficient knowledge, but felt a lack of confidence in decision-making and practical experience. Less experienced ECPs sought more definitive guidance to support their decision-making. ECPs desired clarity on their duty of care obligations and were concerned over possible future litigation if they had not offered, or referred for, myopia management when indicated. The greatest barrier appears to be financial—treatment is expensive and ECPs are uncomfortable communicating this to parents. Many barriers were indicative of systemic problems within UK eyecare, such as commercial pressures, inadequate National Health Service funding and poor public awareness of paediatric eyecare.ConclusionMyopia management is not implemented consistently across the UK. To improve accessibility, changes are required at multiple levels, from individual ECPs through to wider stakeholders in UK eyecare provision.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Eyecare practitioner perspectives and attitudes towards myopia and myopia management in the UK

Coverdale,

Rountree,

Webber

et al. 2024

BMJ Open Ophth

View full text Add to dashboard Cite

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The BONSAI (Brain and Optic Nerve Study with Artificial Intelligence) deep learning system can accurately identify pediatric papilledema on standard ocular fundus photographs

Lin,

Najjar,

Tang

et al. 2024

Journal of American Association for Pediatric Ophthalmology and

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The Increasing Burden of Emergency Department and Inpatient Consultations for “Papilledema”

Ray,

Okrent Smolar,

Dattilo

et al. 2024

Journal of Neuro-Ophthalmology

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Background: Increasing incidence of idiopathic intracranial hypertension (IIH), overreported radiologic signs of intracranial hypertension, difficult access to outpatient neuro-ophthalmology services, poor insurance coverage, and medicolegal concerns have lowered the threshold for emergency department (ED) visits for “papilledema.” Our objective was to examine referral patterns and outcomes of neuro-ophthalmology ED and inpatient consultations for concern for papilledema. Methods: At one university-based quaternary care center, all adults referred for “papilledema” over one year underwent a standardized ED “papilledema protocol.” We collected patient demographics, final diagnoses, and referral patterns. Results: Over 1 year, 153 consecutive patients were referred for concern for papilledema. After papilledema protocol, 89 of 153 patients (58%) had bilateral optic disc edema, among whom 89% (79/89) had papilledema (intracranial hypertension). Of the 38 of 153 (25%) consultations for suspected disorder of intracranial pressure without previous fundus examination (Group 1), 74% (28/38) did not have optic disc edema, 21% (8/38) had papilledema, and 5% (2/38) had other causes of bilateral disc edema. Of the 89 of 153 (58%) consultations for presumed papilledema seen on fundus examination (Group 2), 58% (66/89) had confirmed papilledema, 17% (15/89) had pseudopapilledema, and 9% (8/89) had other causes of bilateral optic disc edema. Of the 26 of 153 (17%) patients with known IIH (Group 3), 5 had papilledema and 4 required urgent intervention. The most common diagnosis was IIH (58/79). Compared with IIH, patients with secondary causes of intracranial hypertension were older (P = 0.002), men (P < 0.001), not obese (P < 0.001), and more likely to have neurologic symptoms (P = 0.002). Conclusion: Inpatient and ED consultations for “papilledema" are increasing. Of the 153 ED and inpatient neuro-ophthalmology consultations seen for “papilledema" over 1 year, one-third of patients with optic disc edema of unknown cause before presentation to our ED had new vision- or life-threatening disease, supporting the need for prompt identification and evaluation of optic disc edema in the ED. In the face of limited access to neuro-ophthalmologists, this study supports the need for emergency department access to expert eye-care evaluation or ocular fundus camera for prompt identification of optic disc edema and standardized evaluation for neurologic emergencies.

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Impact of the COVID-19 pandemic and Honey Rose case on hospital attendances of patients suspected to have papilloedema

Cited by 3 publications

References 3 publications

Eyecare practitioner perspectives and attitudes towards myopia and myopia management in the UK

Eyecare practitioner perspectives and attitudes towards myopia and myopia management in the UK

The BONSAI (Brain and Optic Nerve Study with Artificial Intelligence) deep learning system can accurately identify pediatric papilledema on standard ocular fundus photographs

The Increasing Burden of Emergency Department and Inpatient Consultations for “Papilledema”

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