Referrals from an Optometric Practice to the Hospital Eye Services in Singapore A Two-Year Pre- & During-Covid Retrospective Study

Research Article

J Ophthalmol & Vis Sci. 2022; 7(3): 1071.

Referrals from an Optometric Practice to the Hospital Eye Services in Singapore – A Two-Year Pre- & During- Covid Retrospective Study

Tan LL1*, Koh LH2, Koh KK3, Koh KR3 and Koh KY4

1School of Chemical & Life Sciences, Singapore Polytechnic, Singapore

2Pearl’s Optical Co. Pte Ltd., Singapore

3Undergraduate, National University of Singapore, Singapore

4High School, Anglo-Chinese School (Independent), Singapore

*Corresponding author: Li Li Tan, School of Chemical & Life Sciences, Singapore Polytechnic, 500 Dover Road, Singapore

Received: August 11, 2022; Accepted: September 06, 2022; Published: September 13, 2022

Abstract

Purpose: This two-year retrospective study investigated the referral rate and eye conditions referred from an optometric practice in Singapore pre- and during-Covid.

Materials & Methods: Data collection (audit period) was done from Mar to May 2021. In total, 10582 patient records seen during the period of 14 Feb 2019 to 6 Feb 2021 were extracted. Five thousand three hundred and seventyeight records were done in Year 1 (pre-Covid: 14 Feb 2019 to 31 Jan 2020) and 5204 records were done in Year 2 (during-Covid: 1 Feb 2020 to 6 Feb 2021). Data was then tabulated on patient’s demography (age, gender, ethnicity), audit period, whether the patient was referred, Referral Reply Received (RRR) and the eye conditions being referred, that was categorized to anterior eye anomalies, posterior eye anomalies, glaucoma related eye anomalies and others eye anomalies.

Results: Total eye examination done pre-Covid was 5378 and 709 of them were referred (13.2%) with RRR at 42 (5.9%). Total eye examination done during-Covid was slightly lesser at 5204 and 645 of them were referred (12.4%) with RRR at 28 (4.3%). Majority of patients referred are Chinese and aged more than 60 years. 73% of the patients referred pre-Covid and 63% of the patients referred during-Covid were asymptomatic. The most commonly referred eye conditions were glaucoma, cataract/PCO, retinal and macular anomalies.

Discussion: High referral rate shown in this study does not represent the referral rate in the country as the data was collected in a single optometric practice. This study has demonstrated the role of optometrists in primary eye care through early detection of various eye conditions and save sight.

Keywords: Referral; Optometrists; Ophthalmologists; Hospital eye services; Pre-Covid; During-Covid

Introduction

In Singapore, optometrists’ roles are limited compared to their counterparts elsewhere [6] as they are not licensed to use diagnostic pharmaceuticals. A survey on 230 optometrists in Singapore has shown that though their self-reported primary eye care knowledge is high, their confidence in screening and co-managing chronic eye conditions was low. There were evidence-based answers to issues revolving around optometrists’ readiness for a role expansion [6]. The Optometrists & Opticians Board (OOB) is the regulating authority for optometrists and opticians in Singapore. According to OOB, optometrists are primary eye care providers who specialize in performing eye examinations and refer their patients to ophthalmologists when eye diseases is detected [10]. To date, there is no report on the optometrists’ referral to Hospital Eye Services (HES) ophthalmologist in Singapore.

There have been few reports on referral rate in other countries. A paper in United States on 15 research studies over 33 years of research (1961-1993) has reported a referral rate of 3.83 - 5.5% by optometrists to ophthalmologists and other providers. In the study, cataract and glaucoma were the most common conditions referred. Optometrists in private practice appear to be referring patients at rates consistent with referrals by optometrists who practice in more managed environments [1]. A study in Australia has reported an overall referral rate of 9% for all ages; where 2.4% were asymptomatic. There was a similar number of asymptomatic patients referred in the adult (20 to 64 years) age group compared to all ages (2.5%) [3]. Studies in the UK reported a referral rate ranged from 3.6% to 8.7% from community optometrists to HES [5,17]. On the other hand, El- Abiary et al. [4] reported an average referral rate from community optometry to HES that shown to have increased from 2.5% to 4.1% from 2010/11 to 2018/19 throughout Scotland with a 14.8% annual rise in optometry referrals to HES.

Covid-19 pandemic in Singapore is part of the worldwide pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first case in Singapore was confirmed on 23 January 2020. Early cases were primarily imported until local transmission began to develop in February and March 2020 [2]. In this study, Feb 2020 was taken as a cut-off date for the start of Covid era in Singapore, in view of the surge in community cases. This study investigated the referral rate and eye conditions referred from a well equipped optometric practice in Singapore pre-Covid (a year before Feb 2020) and during-Covid (a year from Feb 2020 onwards) period.

Materials and Methods

This is a two-year retrospective study. Data collection (audit period) was done from Mar to May 2021 by three individuals (KK, KR and KY). In total, 10582 patient records seen in Pearl’s Optical Co. Pte Ltd. during the period of 14 Feb 2019 to 6 Feb 2021 were extracted. Five thousand three hundred and seventy-eight of the records were done in Year 1 (pre-Covid: 14 Feb 2019 to 31 Jan 2020) and 5204 of the records were done in Year 2 (during-Covid: 1 Feb 2020 to 6 Feb 2021). Data was then tabulated on patient’s demography (age, gender, ethnicity), audit period, whether the patient was referred, Referral Reply Received (RRR) and the eye conditions being referred, that was categorized to anterior eye anomalies, posterior eye anomalies, glaucoma related eye anomalies and others eye anomalies (Table 1). This study was granted exempt status by the Institutional Review Board of Singapore Polytechnic.