Surveillance of sight loss due to delay in ophthalmic treatment or review: frequency, cause and outcome

Abstract

Purpose To determine the frequency of patients suffering harm due to delay in ophthalmic care in the UK over a 12-month period. Methods Patients with deterioration in vision in at least one eye of 3 lines of Snellen acuity or 15 letters on ETDRS chart or deterioration in visual field deviation of 3 decibels due to health service initiated delay in review or care were ascertained through the BOSU using prospective active surveillance involving all UK consultant ophthalmologists. Demographic details, diagnosis, cause and length of delay, and vision loss were then sought by questionnaire. Results 238 cases reported between March 2015 and February 2016. 197/238 questionnaires were returned (83%). Twentyeight reports were out of the study period or did not meet the case definition. Median age was 76 years (range: 1 to 98 years). Median delay was 22 weeks (range: 2 days to 5½ years). Seventy two per cent experienced permanent reduction in visual acuity, 23% permanent deterioration in visual field. Main diagnoses were Glaucoma 42%, Age-related Macular Degeneration (AMD) 23%, and Diabetic Retinopathy (DR) 16%. Eighteen patients were eligible for Severely Sight Impaired (SSI) or Sight Impaired (SI) registration. Main causes were delayed follow-up (76%), lost referral (7%), and delayed treatment (8%). Conclusion Patients are suffering preventable harm due to health service initiated delay leading to permanently reduced vision. This is occurring in patients of all ages, but most consistently in those with chronic conditions. Delayed follow-up or review is the cause in the majority of cases indicating a lack of capacity within the hospital eye service.

Glaucoma management in primary care: barriers perceived by optometrists in Scotland

“…2,3 Over the last decade there has been an almost 40% increase in eye outpatient clinic attendances in the UK. 4 The population of Scotland is projected to rise to 5.7 million by 2039, and that population will age significantly, with the number of people aged 65 years or older increasing by 53% between 2014 and 2039. 5 Increasing age is the leading non-ocular risk factor for the development of primary open angle glaucoma (POAG).…”

Real‐world visual outcomes in patients with neovascular age‐related macular degeneration receiving aflibercept at fixed intervals as per UK licence

“…3 As reported in a recent British Ophthalmic Surveillance Unit (BOSU) publication, it is not uncommon for patients in the UK National Health Service (NHS) with chronic ophthalmic conditions to suffer harm due to delays in receiving appropriate ophthalmic care, often because of limited resources. 4 The purpose of this study was to identify the proportion of patients receiving the mandated eight intravitreal aflibercept injections in the first year of treatment for nAMD in a single UK public hospital and to identify the impact on vision of reduced injection frequency as well as reasons for this undertreatment.…”

The COVID-19 pandemic will redefine the future delivery of glaucoma care

“…The provision of safe and effective glaucoma care even prior to the current COVID-19 pandemic has been challenging. The British Ophthalmological Surveillance Unit found that up to 22 people per month suffered permanent and severe vision loss as a consequence of delayed follow-up, due to insufficient capacity within hospital eye services [2]. Formal Investigation by the Healthcare Safety Investigation Branch [3] made several recommendations including the need for appropriate specialist-led clinical decision making, clinical pathway redesign, improved referral refinement schemes and validation of risk stratification.…”