Pattern of referrals by Optometrists in Nigeria in relation to glaucoma and diabetic retinopathy
Referrals from primary care practitioners such as optometrists to other health care providers is critical to the health 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 37th annual general meeting of the Nigerian Optometric Association. Of the 58 respondents, 51 (87.9%) of the respondents based their diagnosis of glaucoma on the triad of raised intra-ocular pressure (IOP), cup-disc (C/D) ratio and characteristic visual field defect while 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 ocular signs 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 patient to a medical personnel/physician. Forty-four (75.9%) of the respondents reportedly performs visual field test (VFT) while 14 (24.1%) do not perform VFT. A total of 31 (53.4%) of the respondents reported that they will initiate treatment for a glaucoma patient before referring the patient to an ophthalmologist while 10 (17.2%) will refer glaucoma patient outright to an ophthalmologist. With respect to the stage of diabetic retinopathy that will warrant a referral, 42 (72.4%) of the respondents refer the patient at any stage when the diagnosis 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), 36-44
Keywords: Optometry, Ophthalmology, referral, Nigeria, glaucoma