BMJ 1994;309:634-636 (10 September)

Papers

The sight test fee: effect on ophthalmology referrals and rate of glaucoma detection

D A H Laidlaw, P A Bloom, , Eye Hospital, Bristol BS1 2LX Department of Epidemiology and Public Health Medicine, University of Bristol, Bristol BS8 2PR Department of Ophthalmology, University of Bristol, Bristol BS1 2LX Correspondence to: Mr Laidlaw.,a A O Hughes, J M Sparrow, V J Marmion 

a Bristol

Abstract

Objective : To assess changes, if any, in the numbers of referrals and outcome of glaucoma referrals to the hospital eye service since the introduction of the sight test fee on 1 April 1989.
Design : Review of referral records and clinical notes.
Setting : Referrals to the Bristol Eye Hospital.
Subjects : 51 919 patients referred to the Bristol Eye Hospital between 1984 and 1992. 9438 case notes of patients referred between 1987 and 1991 were examined in detail.
Main outcome measures : Numbers of referrals; rate of adult true positive glaucoma referrals.
Results : Referrals to the Bristol Eye Hospital were between 13.7% and 19.0% fewer than expected20after the introduction of the sight test fee. True positive glaucoma referrals were reduced by the same proportion. Conclusions - The numbers of patients being identified as requiring treatment or follow up for potentially blinding glaucoma have declined by nearly one fifth since the introduction of the sight test fee. An increased prevalence of preventable blindness may result.

Clinical implications

  • Clinical implications

  • The sight test is the only existing means of screening adults in Britain for treatable but potentially blinding ocular diseases such as glaucoma

  • Since 1 April 1989, 60% of adults have had to pay for sight tests

  • During 1989-92 up to 19% fewer than expected new patient referrals were received at the Bristol Eye Hospital

  • True positive glaucoma referrals were also reduced by 19%

  • The rate of identification of glaucoma has declined by nearly one fifth in Bristol since the introduction of the sight test fee

  • An increased prevalence of preventable blindness may be expected


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