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Surveillance of Sight Loss due to delay in ophthalmic review in the UK: Frequency, cause and outcome

Abstract: Surveillance of Sight Loss due to delay in ophthalmic review in the UK: Frequency, cause and outcome

Mr Barny Foot, Fellow – The British Ophthalmological Surveillance Unit (BOSU)
Professor Caroline MacEwen – President, The Royal College of Ophthalmologists

Introduction

The Royal College of Ophthalmologists and other patient safety organisations have identified concerns over patients experiencing harm due to delays in ophthalmic care. This is reflected by ophthalmologists’ clinical experience.

Purpose

To determine the frequency of patients suffering harm due to delay in ophthalmic care in the UK over a 6 month period.

Method

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

125 cases reported between February and July 2015. 101/125 questionnaires were returned (81%). 15 reports were out of the study period or did not meet the case definition. Median age was 76 years (range: 1 to 95 years). Median delay was 18 weeks (range: 1 week to 13 years). 74% experienced permanent reduction in visual acuity, 51% permanent deterioration in visual field. Main diagnoses were Glaucoma 41%, Age-related Macular Degeneration (AMD) 28% and Diabetic Retinopathy (DR) 12%. 18 patients were eligible for Severely Sight Impaired (SSI) or Sight Impaired (SI) registration. Main causes were delayed follow-up (61%), lost referral (13%) and delayed treatment (8%).

Conclusion

NHS Patients are suffering preventable harm due to health service initiated delay leading to permanently reduced vision.

May 2016