Research

A pilot study for a randomised controlled trial of a general practice based Optometry service for people aged 65 or over

Mr Faisal Bashir

In collaboration with epidemiologists based at the London School of Hygiene and Tropical Medicine (LSHTM) and Richard Wormald, an ophthalmologist at Moorfields Eye Hospital (MEH).

LSHTM is providing logistical and epidemiological support for the pilot and will be heavily involved in the major study. The records of any subjects referred to MEH will be reviewed by Richard Wormald.

Background

Visual problems among older people are common and associated with reduced functional status, independence and quality of life, lower levels of social contact, falls and hip fractures. A range of effective interventions to improve vision, prevent deterioration, or ameliorate the effects of visual loss exists. However, in spite of the re-introduction of sight tests paid by the NHS for people aged 60 years or over, high levels of unmet need for eye care among older people have repeatedly been demonstrated.  The problems are due to lack of access at two levels: both entry into a service (for example seeing an optometrist) and also progress through the eye care services (for example obtaining an appropriate cataract extraction).

There have been no previous randomised trials that aimed to evaluate a general practice based optometry service for older people. The aim of such a trial would be to evaluate a strategy to improve access to a primary care service, focusing on older people among whom the burden of unmet need for eye health care is highest.

Methodology

In this pilot study, sessional optometry clinics will be held in two different general practices, one in a relatively affluent and one in a relatively deprived area.  Both practices already routinely refer to Moorfields Eye Hospital to facilitate piloting of direct referral by optometrists to ophthalmology services and to aid data collection in the pilot study.

The subjects will undergo a standard eye examination.  Spectacle prescriptions will be issued on the practice headed paper. Those who would benefit from correction (improvement of VA to 6/12, N8 or better) will be encouraged to have the prescription made; a list of registered optometric practices within the locality will be issued with no preference for a practice. A protocol for referring patients with ocular disease directly to Moorfields Eye Hospital will be used. Those with ocular signs of systemic disease will be notified to the general practitioner.

The consent obtained from participants will permit full access to their medical records. Information about contact with eye health services from the general practice records will be extracted.

In order to assess the effect of direct optometry referral to secondary eye care services, the hospital records of participants records will be examined three months after the referral and information relating to the referral be extracted.

The main aims of the pilot are to develop and optimise the intervention and trial procedures and this will be an iterative procedure facilitated by reports.

We will also collect data regarding the proportion of people with unmet need for access to eye health services. This is defined as any of the following:

Outcomes

It is hoped that the results of this study could inform possible improvements to access to a primary care service (optometry) for the elderly. In addition direct referral to hospital by primary care optometrists will be evaluated.