Authors (including presenting author) :
Chow KF(1), Chan SC(2), Kam KW(2), Young AL(2), Chan TB(1), Leung WK(1), Choi YK(1), Leung SY(1), Leung KW(1)
Affiliation :
(1)Department of Family Medicine, Prince of Wales Hospital, New Territories East Cluster; (2)Department of Ophthalmology & Visual Sciences, Prince of Wales Hospital & Alice Ho Miu Ling Nethersole Hospital, New Territories East Cluster.
Keyword 1: :
Blurring of vision
Keyword 2: :
Collaboration
Keyword 3: :
Family Medicine
Keyword 4: :
Ophthalmology
Introduction :
In the era of aging population, unsurprisingly there is increase in demand in ophthalmology service due to age-related conditions. A local audit on referrals showed about half of the referrals to Ophthalmology Clinic was due to blurry vision or cataract. The main reasons are due to lack of appropriate equipment and expertise in assessment. Indeed, not all patients require ophthalmologist’s intervention. Family physicians (FPs) can provide eye care advice with the support of detailed eye assessment.
Objectives :
To evaluate the feasibility of a new service model for managing patients with non-acute vision blurring in the Family Medicine Clinic (FMC), aiming to reduce unnecessary referrals while expediting those with alarming features to the Ophthalmology Clinic.
Methodology :
In essence, an Optometrist Assessment Session (OAS) is set up by Department of Ophthalmology located at FMC to assist FPs to triage the aforesaid patients. The inclusion criterion is patient who attends FMC presenting with painless blurring of vision for more than 3 months. FPs will select suitable patients and, instead of direct referral to the Ophthalmology Clinic, arrange them to see FMC-based optometrist (i.e. the OAS) for risk stratification, which includes visual acuity examination with pinhole, intraocular pressure and refractive error measurement, slit lamp biomicroscopy and fundus photography. The optometrist’s assessment will classify patients based on the criteria set by the ophthalmologist, suggesting whether to discharge the patient to a community optometrist, or to refer them for either routine or early evaluation at the Ophthalmology Clinic. FP specialists will provide subsequent consultation to these patients, give advice and make the final decision. An ophthalmologist in-charge provides atlas for the optometrist and oversees the OAS.
Result & Outcome :
The pilot programme has started since Aug 2024 with once-monthly OAS in FMC. As of Dec 2025, 120 patients have been recruited by FPs, with an attendance rate to OAS being 98% (n=117), subsequent referral rate to Ophthalmology Clinic after seeing FP specialists being 33% (n=39). The reasons of for referrals include moderate cataract eligible for surgery, posterior capsular opacification eligible for laser treatment, and epiretinal membrane. Five patients with wet AMD, or raised intraocular pressure and/or cupping of optic disc - were referred as priority and all were triaged an early appointment at Eye Clinic (within 2-6 months) instead of routine (> 27 months). . In other words, among the patients enrolled in such collaborative service model, 67% of them can be safely managed in FMC alone without need of referral to Ophthalmology Clinic. The reassurance to these patients (i.e., managed in FMC alone) showed lasting effect, as evident by the “One-year Referral Rate” (defined as the aforesaid patients who are nevertheless found to have an HA Ophthalmology Clinic appointment when we check the CMS at the anniversary of individual OAS being conducted), which is essentially zero (except 1 patient who are found to have an HA Ophthalmology Clinic appointment due to RAMP-DM protocol-driven referral).
