Vision screening in children:a retrospective study of social and demographic factors with regard to visual outcomes

BACKGROUND: Amblyopia and its risk factors have been demonstrated to be more common among children from low socioeconomic backgrounds. We sought to investigate this association in a region with orthoptic-delivered screening and whole population coverage, and to also examine the association of the Health Plan Indicator (HPI) with screening outcome. METHODS: Screening examination outcomes, postcodes and HPIs were extracted from the community child health database for every child who underwent preschool vision screening between March 2010 and February 2011 Tayside. We obtained the Scottish Index of Multiple Deprivation score for every child as a measure of area-based deprivation. We assessed the vulnerability/needs of the individual family through the HPI—‘Core’ (children and families receiving universal health visiting service), ‘Additional’ (receiving additional health/social support) and ‘Intensive’ (receiving high levels of support). The outcomes from follow-up examinations for those who failed screening were extracted from the orthoptic department database. RESULTS: 4365 children were screened during the year 2010–2011 of whom 523 (11.9%) failed. The odds of children from the least deprived socioeconomic group passing the visual screening test was 1.4 times higher than those from the most deprived socioeconomic group (OR 1.4, 95% CI 1.07 to 1.89, p=0.01). The odds of a child from a family assigned as ‘Intensive’ failing the preschool visual screening test was three times greater than the odds of a child from a family assigned as ‘Core’ (OR 3.59, 95% CI 1.6 to 7.8, p=0.001). CONCLUSIONS: We found that children from the most deprived backgrounds and those from unstable homes were more likely to fail preschool vision screening

Impact of socioeconomic deprivation on the development of diabetic retinopathy: a population-based, cross-sectional and longitudinal study over 12 years

OBJECTIVE: To study the association between socioeconomic deprivation and prevalence of diabetic retinopathy (DR). DESIGN: Population-based, cross-sectional observational study and retrospective longitudinal analysis over 12 years. SETTING: Primary care, East of Scotland. METHODS: Outcome data from DR screening examinations (digital retinal photography) were collected from the Scottish regional diabetes electronic record from inception of database to December 2012. The overall Scottish Index of Multiple Deprivation (SIMD) 2012 score for each patient was obtained using their residential postcode. Multiple binary logistic regression was used to analyse the relationship between overall SIMD score and prevalence of DR, adjusting for other variables: age, gender, glycated haemoglobin, cholesterol levels and duration of disease. PRIMARY OUTCOME: Any retinopathy (R1 and above) in either eye. RESULTS: A total of 1861 patients with type 1 diabetes mellitus (DM) and 18 197 patients with type 2 DM were included in the study. Prevalence of DR in type 1 and type 2 DM were 56.3% and 25.5%, respectively. Increased prevalence of DR in type 1 DM was associated with higher overall SIMD score (p=0.002), with an OR for the most deprived relative to the least deprived of 2.40 (95% CI 1.36 to 4.27). In type 2 DM, the overall SIMD score was not significantly associated with increased prevalence of DR, with an OR for the most deprived relative to the least deprived of 0.85 (95% CI 0.71 to 1.02, p=0.07). CONCLUSIONS: Socioeconomic deprivation is associated with increased prevalence of DR in patients with type 1 DM and this occurs earlier. This highlights the need for targeted interventions to address inequalities in eye healthcare

Out of hours ophthalmic surgery:a UK national survey

AIMS: There have been significant changes in the management of out of hours services in ophthalmology recently. The European Working Time Directive (EWTD) and economic measures have anecdotally reduced the availability of staff and facilities outside normal working hours, and there have been various responses to the provision of emergency surgical care. There are disparate attitudes to the optimum management of the emergency surgical case. We sought to establish a nationwide picture of the management of out of hours surgery. METHODS: A questionnaire was distributed to every consultant ophthalmologist working in the NHS and registered with the Royal College of Ophthalmologists (n=947). Information was requested regarding departmental and personal policies, local facilities, and personal beliefs regarding emergency surgery. RESULTS: A total of 440 (46.5%) questionnaires were returned from 155 units; 18.7% of the units had no out of hours services or no operating facilities. Sixty-three percent of units reported a local policy regarding a time after which patients should not be taken to theatre. For 57%, this time began between 2100 hours and midnight. The most common reasons for not operating after a certain time were ‘belief that delay does not significantly affect the outcome' (41.6%), ‘delayed access to theatre due to competition with other surgical specialities' (40%), and ‘no specialist ophthalmic-theatre nursing input' (32.7%). CONCLUSION: We report the first nationwide study on out of hours ophthalmological surgical working practices. This demonstrates variation in work patterns. It is significant to patients and ophthalmologists that there should be units in United Kingdom without full local facilities and staff