Research article

Suspected retinopathies in Norwegian optometric practice with emphasis on patients with diabetes: a cross-sectional study

Vibeke Sundling¹ , Pål Gulbrandsen² , Ragnheiður Bragadottir³ , Leiv S Bakketeig⁴ , Jak Jervell⁵ and Jørund Straand⁶

¹  Department of Optometry and Visual Science, Buskerud University College, Kongsberg, Norway

²  Helse Øst Health Services Research Centre, Akershus University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway

³  Department of Ophthalmology, Ullevål University Hospital Faculty Division Ullevål University Hospital, University of Oslo, Oslo, Norway

⁴  Division of Epidemiology, National Institute of Public Health, Oslo, Norway

⁵  Professor Emeritus, Bygdøy alle 25 A, 0262 Oslo, Norway

⁶  Department of General Practice and Community Medicine, University of Oslo, Oslo, Norway

author email corresponding author email

BMC Health Services Research 2008, 8:38doi:10.1186/1472-6963-8-38

Published:	8 February 2008

Abstract

Background

The scope of optometry differs worldwide. In Norway the vast majority of optometrists perform ophthalmoscopy as part of their routine examinations. The aim of this study was to describe the frequency of suspected retinopathies in patients seen for routine optometric examination and to determine how optometrists deal with these patients.

Methods

212 optometrists participated in a questionnaire survey and a practice registration during November 2004 – May 2005. In the practice registration, details for 20 consecutive patient encounters were recorded. Data were analysed by chi-square tests and multiple logistic regression.

Results

All optometrist stated that ocular history taking was an integrated part of their routine examination, while general health and diabetes history were routinely addressed by 59% and 42% of the optometrists, respectively. During the practice registration 4,052 patient encounters were recorded. Ophthalmoscopy was performed in 88% of the patients, of which 2% were dilated fundus examinations. Retinopathy was suspected in 106 patients, of whom 31 did not report a previous history of ocular or systemic disease. Old age (75+), hypertension and diabetes strongly predicted retinopathy with odds ratio (95% CI) of 6.4 (4.2 to 9.9), 3.8 (2.4 to 6.0) and 2.5 (1.4 to 4.7), respectively. Diabetic retinopathy was seen in 10% of diabetic patients and suspected in 0.2% of patients with no established history of diabetes. Retinopathy was not confirmed in 9 out 18 patients with a history of diabetic retinopathy; seven of these had undergone laser treatment. Out of the 106 patients with findings of retinopathy, 28 were referred to an ophthalmologist or a general practitioner (GP), written reports were sent to a GP in 16 cases, ten patients were urged to contact their GP for further follow up, while 52 were considered in need of routine optometric follow up only.

Conclusion

Optometric practice provides a low threshold setting for detecting cases of ocular disease and retinal manifestations of systemic disease in the population. At present diagnosis of retinopathy in Norwegian optometric practice is unreliable. There are potentials for improving the optometrists' routine examination, their patient management patterns and collaboration routines with medical doctors.