GP referrals may explain fivefold difference in rates of squint surgery across England

BMJ 2013; 346 doi: (Published 11 April 2013) Cite this as: BMJ 2013;346:f2268
  1. Zosia Kmietowicz
  1. 1BMJ

The proportion of children aged under 15 years in England undergoing surgery to correct squint has fallen threefold in the past 50 years, though there is much variation in the proportion around the country, a study has found.

Researchers from Surrey, London, and Oxford used routine hospital data collected as part of the Oxford record linkage study from 1963 to 2010 and figures from across local authorities in England from 1968 to 2010 to look at how surgery for squints had changed. They published their findings online in the British Journal of Ophthalmology.1

Altogether 519 089 children under the age of 15 were admitted for corrective surgery for squint across England during the study period. But the researchers found that annual admission rates fell from 188.8 per 100 000 of the population aged under 15 in 1968 to 64.1 per 100 000 in 2010. Most of the fall in admissions occurred between the 1970s and the 1990s.

There was also a fivefold difference between the area with the lowest number of admissions for corrective squint surgery (the London borough of Kensington and Chelsea, with 28.2 per 100 000 of the child population) and that with the highest (Easington in County Durham, with 136.8 per 100 000).

The researchers calculated that this variation was almost as great as that for tonsil removal.

The local authorities with higher rates of surgery were marginally more likely to be in areas of relatively high deprivation, but this factor accounted for only a fraction (5.3%) of the variance they found.

A large part of the decline in surgery to repair squints was likely to be because of a switch from surgical to non-surgical treatment rather than a genuine fall in the prevalence of squint, said the authors.

But the reasons for the geographical variation were less clear. The variation may have reflected genuine differences in need, or it may have been because of differences in doctors’ clinical judgment, the authors said.

“Of the various explanations for geographical variation, the most important single one may be variation in clinical judgement—by general practitioners in referring patients for surgery, and by ophthalmologists in the thresholds for recommending surgery,” they wrote.

The variations should be investigated further to see whether they were clinically warranted, the authors concluded.


Cite this as: BMJ 2013;346:f2268