The quality, accuracy and appropriateness of UK optometric age‐related macular degeneration referrals

TL;DR

This study evaluates the accuracy of optometrists' referrals for a type of eye disease in the UK, finding that while referrals are generally well-written, only about 40% correctly identify the condition.

Contribution

The study provides the first detailed analysis of referral accuracy for neovascular age-related macular degeneration by UK optometrists.

Findings

Only 39.8% of referrals for neovascular age-related macular degeneration were accurate.

Visual acuity was the strongest indicator associated with a confirmed diagnosis.

Referral accuracy dropped significantly during the COVID-19 pandemic.

Abstract

Little is known about the quality of optometrists' referrals to secondary care for neovascular age‐related macular degeneration (nAMD), despite the need for timely intervention. We analysed the content and accuracy of optometrists' referrals for nAMD. Adherence to UK National Institute for Health and Care Excellence (NICE) guidelines and the impact of the COVID‐19 pandemic were assessed as secondary measures.

Optometric referrals to a specialist macular treatment centre in Bradford, United Kingdom, between March 2019 and March 2021 were retrospectively analysed and compared with subsequent electronic medical records. Data were extracted on legibility, reason for referral, patient and optometrist demographics, visual acuity, reported signs and symptoms, patient diagnosis and patient outcomes. Binomial logistic regression models were constructed to determine whether signs or symptoms noted in the referral were associated with subsequent nAMD diagnosis in secondary care and whether optometrist gender or experience influenced nAMD referral accuracy.

Across all 394 referrals analysed, 256 were for nAMD. Referral accuracy for nAMD was 39.8% (95% CI [34.0%, 45.9%]), with the most common reason for misdiagnosis being dry AMD. However, 76.8% of patients referred for suspected nAMD were either treated in secondary care or observed over multiple visits. 20% of suspected nAMD patients were seen within the NICE recommended 14‐day window pre‐COVID, dropping to 5% during the pandemic (p < 0.001). Visual acuity was most strongly associated with nAMD diagnosis (χ2(1) = 13.71, p < 0.001) followed by macular haemorrhage (χ2(1) = 5.89, p = 0.02). Neither optometrist gender nor experience was significantly associated with confirmed nAMD. Legibility of referrals was 91–95% for patient details and 94–97% for the referring optometrist.

Although the overall quality and legibility of optometrists' macular referrals to secondary care were of a high standard, the diagnostic accuracy of nAMD was below 40%. Referred visual acuity was the main sign/symptom associated with confirmed nAMD diagnosis.

Figures