Pattern of referrals by Optometrists in Nigeria in relation to glaucoma and diabetic retinopathy

Abstract

Referrals from primary care practitioners such as optometrists to other health care providers is critical to thehealth care delivery system of any society. This study explores the pattern of referrals of Nigerian optometrists with respect to glaucoma and diabetic retinopathy. A cross-sectional survey using a 28-item questionnaire was administered to optometrists attending the 37thannual general meeting of the Nigerian Optometric Association. Of the 58 respondents, 51 (87.9%) of the respondents based their diagnosis of glaucoma onthe triad of raised intra-ocular pressure (IOP), cup-disc (C/D) ratio and characteristic visual field defectwhile the remaining seven (12.1%) based their diagnosis of glaucoma on raised IOP and C/D ratio. Fifty-four (93.1%) requested for a fasting blood glucose test (FBG) from patients who presented with ocularsigns indicative of diabetes or diabetic retinopathy. When diabetic retinopathy was observed in a patient, 16(27.6%) responded to refer the patient to an ophthalmologist while eight (13.8%) agree to refer the patientto a medical personnel/physician. Forty-four (75.9%) of the respondents reportedly performs visual fieldtest (VFT) while 14 (24.1%) do not perform VFT. A total of 31 (53.4%) of the respondents reported thatthey will initiate treatment for a glaucoma patient before referring the patient to an ophthalmologist while10 (17.2%) will refer glaucoma patient outright to an ophthalmologist. With respect to the stage of diabeticretinopathy that will warrant a referral, 42 (72.4%) of the respondents refer the patient at any stage when thediagnosis is made while 5 (8.6%) will only refer the patient if there is no improvement in the condition presumably after follow-up care. More female respondents were likely to refer glaucoma patients (OR = 1.556,95% CI = 0.488 4.963) and diabetic retinopathy (OR = 3.682, 95% CI = 0.357 37.922) to ophthalmologists. Majority of Nigerian optometrists refer glaucoma and diabetic retinopathy patients to ophthalmologists; though more than half of the respondents will initiate treatment for glaucoma before referral.Journal of Medical and Biomedical Sciences (2016) 5(3), 36-44Keywords: Optometry, Ophthalmology, referral, Nigeria, glaucoma