A preliminary evaluation of optometric management and referral protocols for pa-tients with diabetic retinopathy

Abstract

Aim: The purpose of this pilot study was to investigate the assessment, management and referral practices of South African optometrists in the care of patients with diabetic retinop-athy (DR) and to recommend strategies to improve and standardize patient management as required. Methods: The study design incorporated quantitative, qualitative and clinical measures that were administered to fourteen experienced optometrists from the Durban area. The quan-titative measure, the questionnaire in appendix I, evaluated the optometrists’ management pro-tocols of patients with diabetes mellitus (DM). These included the optometrists’ referral and co-management practices, their awareness and usage of appropriate guidelines in the man-agement and referral of these patients, their perceived levels of competence and confidence in their education, levels of service offered to the patients and finally the role of Continuous Professional Development (CPD). This self-report information was supplemented by a set of clinical measures where the study sample grad-ed levels of DR, chose appropriate management options and indicated prognosis for disease progression based on a set of slides presented to them. Finally the fourteen optometrists, as well as two ophthalmologists, were interviewed using tailored, semi-structured interview sched-ules. These interviews were used to elaborate and corroborate information obtained from the other two research approaches. Results: Descriptive analysis was used to analyse the data from the quantitative and clinical measures, whilst the interviews were analysed thematically. Although 86% of the sample routinely screened for ocular manifesta-tions of DM, there was no standardization in the criteria used by the fourteen optometrists. Only 15% of the sample reportedly assessed their patients using dilated fundus examina-tions (DFE), which is the internationally rec-ommended standard of care. The results of the clinical measures indicated that there was a lack of standardization in the management and refer-ral of patients with DR by the study sample, contrary to their own levels of confidence in their educational competencies regarding DR and their perception of the level of service that they offered to their patients. The interviews with the optometrists provided crucial insights into this lack of standardised care of patients with DR, with the ophthalmologists confirming the urgent need for CPD aimed at enhancing clinical skills and ensuring standardization in the management and referral of patients with DR. This finding was particularly relevant for co-management models.Conclusion: This pilot study indicates that the performance of the optometrists (albeit a relatively small group) in the assessment, man-agement and referral of patients with DR was inconsistent and not in keeping with interna-tionally recommended guidelines. It is recom-mended that CPD programmes focus on the improvement of clinical skills and on the imple-mentation of existing standardised management protocols for patients with DR. This should result in improved patient care, patient confi-dence and loyalty with regard to care received, efficient and effective models of management and co-management and decreased costs to patients and the health care system.