Investigating cataract referral practices used by Australian optometrists

Abstract

Background

The patient pathway to cataract surgery in Australia generally begins with optometric services; however, little is known about the cataract surgery referral criteria used by optometrists in Australia.

Methods

Members of Optometrists Association Australia were invited to complete an online survey in April 2013. The survey elicited information on practice demographics, professional characteristics of optometrists and cataract surgery referral considerations.

Results

We received responses from 533 of 4272 (13 per cent) practising optometrists. Over three‐quarters (407 of 528, 77 per cent) indicated a visual acuity (VA) cataract referral benchmark of 6/9 to 6/12. Almost all respondents (499 out of 532, 94 per cent) stated they included glare sensitivity as part of their referral criteria, whereas a considerably lower proportion (40 of 528, eight per cent) used contrast sensitivity testing. Patient‐centred factors such as hobbies (94 per cent) and driving (73 per cent) featured in the decision to refer patients sooner, while a patient not wanting surgery (79 per cent) was the most frequent reason cited for delaying referral. Respondents practising in more advantaged socioeconomic areas were 2.4 times more likely to refer privately (95% CI 1.6–3.6) and less likely to consider surgical costs as an important consideration (p < 0.001). Almost all respondents (97 per cent) who referred publicly discussed public hospital waiting times with their patients (median minimum wait estimate of 12 to 18 months), compared to the smaller proportion (64 per cent) of respondents discussing private waiting times (median minimum wait estimate of one to two months).

Conclusion

While modest reductions in VA were sufficient to prompt referral for cataract surgery by Australian optometrists, patient‐reported visual disability guided the optometrist's overall referral decision. Socioeconomic status of practice location influenced the choice to refer publicly versus privately and surgical costs were also considered.

Key words:

• cataract
• contrast sensitivity
• referral practices
• visual acuity

Acknowledgements

The authors of this paper would like to acknowledge Genevieve Quilty and Jared Slater of Optometrists Association Australia for their advocacy and support in the production and distribution of the survey used in this study. Vu Do is supported by a post‐graduate scholarship funded by NSW Health Agency for Clinical Innovation, Lisa Keay is funded by an ARC post‐doctoral fellowship.

Additional information

Funding

NSW Health Agency for Clinical Innovation

ARC post‐doctoral fellowship