Canadian Association of Optometrists. January December March 2016

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1 Canadian Association of Optometrists January December 2015 March 2016 This project provides an actionable data set and recommendations for use by the Canadian Association of Optometrists. March

2 EXECUTIVE SUMMARY... 3 OPTOMETRIST FINDINGS... 3 OPTOMETRY INCIDENT REPORT FORM MEMBER DEMOGRAPHIC DATA... 4 OPTOMETRY INCIDENT REPORT FORM PATIENT DEMOGRAPHIC DATA... 6 OPTOMETRY INCIDENT REPORT FORM INCIDENT DATA... 8 OPTOMETRIST FINDINGS APPENDIX A March

3 Executive Summary Optometrist Findings From January to December , the Optometry Incident Report collected feedback from 192 members. During this collection period, 61% of patients visited an Optometrist as asymptomatic patients. On average, 4 of these patients booked an appointment with an Optometrist to update a prescription not to address a specific ocular condition. Given the high number of patients who exhibit asymptomatic eye disease, early detection is crucial to treatment. However, 18% of patients wait more than 5 years between comprehensive eye examinations. An additional 35% of patients wait between 2 and 5 years between examinations. Together, these segments represent a significant portion of the population who are not aware of their eye health. Data relating to the frequency of patient visits should be used to garner support from national and regional healthcare organizations on the matter of eye examinations. March

4 % respondents Optometry Incident Report Form Member Demographic Data The 192 Optometrists who responded to the 2015 Optometry Incident Report (OIR) provided insight into the regions that contribute the most to their industry association. 35% FIGURE 1.1 MEMBER LOCATION Historic View 3 25% 2 15% 5% British Columbia Alberta Saskatchewan Manitoba Ontario Quebec New Brunswick Nova Scotia Prince Edward Island Newfoundland/Labrador Yukon Year Northwest Territories Nunavut n=2,553, English and French responses, Optometry Incident Report ; n=326, English and French responses, Optometry Incident Report 2014 Question: Please select the province in which you practice The 2015 year-end data revisits reporting trends experienced from New Brunswick and Manitoba returned to their previously high reporting positions, while BC, Ontario, Nova Scotia and Newfoundland/Labrador fell back to their traditional reporting habits. March

5 Year of response # respondents FIGURE MEMBER LOCATION Responses by month Prince Edward Island Nova Scotia New Brunswick Quebec Ontario Manitoba Saskatchewan Alberta British Columbia Month Question: Please select the province in which you practice Upon the launch of the new OIR survey in August 2015, responses rose dramatically compared to other months. In particular, responses from New Brunswick increased remarkably. FIGURE 1.3 LANGUAGE OF RESPONSE HISTORIC VIEW % 92% % 9 French English % 95% % respondents n=2,553, English and French responses, Optometry Incident Report ; n=326, English and French responses, Optometry Incident Report 2014 Question: Language of response March

6 Year From , an average of 9 of OIR respondents provided feedback in English. On average, 7% of respondents provided feedback in French. Optometry Incident Report Form Patient Demographic Data Since the questions on patient sex and age became obligatory in the 2014 OIR, responses about male patients have increased by 9%. Male patients may be visiting their Optometrists more frequently than they were prior to FIGURE PATIENT SEX % 45% % 48% Male Female % 54% % respondents n=2,399, English and French responses, Optometry Incident Report ; n=326, English and French responses, Optometry Incident Report 2014 Question: Patient sex While members reported more visits from male patients in 2015, this data must be considered with caution given the small sample size. March

7 % incidents FIGURE PATIENT AGE 5 45% 4 35% 3 25% 2 15% 5% 44% 29% 18% 7% 2% Patient age Question: Patient age The majority of patients reported in the 2015 OIR fall into the age bracket, followed by patients aged This data is consistent with historical trends. In 2015, the age brackets listed in the OIR were altered to better reflect reporting trends seen in previous years. As such, year-over-year trending is not possible until For historical data, please see Appendix A. March

8 % incidents Optometry Incident Report Form Incident Data Data disclosed in the Optometry Incident Report indicates that in 61% of the cases reported the patient did not present with symptoms related to the underlying condition or diagnosis. 34% of cases were related to corrective lenses acquired via the Internet; 25% of these cases stemmed from the incorrect or unsafe glasses or contact lenses dispensed via the Internet while 9% of these cases included glasses or contact lenses dispensed via the Internet from an invalid, expired or modified prescription. The remaining 5% of reported incidents were based on sight tests. of reported incidents were based on an incorrect prescription generated by stand alone sight test, while 2% of incidents were based on a stand alone sight test performed for provision of optical appliance when the omission of an ocular health assessment put the patient at risk % Asymptomatic findings FIGURE REPORTED INCIDENTS 25% Incorrect corrective lenses via the internet 9% Invalid, expired or modified prescription via the internet 2% Incorrect prescription generated by stand alone sight test Stand alone sight test & omission of an ocular health assessment Question: Select the reason for the patient s visit In 2015, the question regarding reason for patient s visit was altered. For historical data, please see Appendix A. March

9 % incidents The most frequent reasons for visiting an Optometrist, according to the OIR, include updating a prescription (~4 of patients), blurred vision (~12% of patients) and ongoing care (~7% of patients). of cases respectively were related to Asthenopia/eyestrain, headaches, double vision or symptomatic ocular disease with diagnosis delayed due to patient first undergoing a sight test instead of a timely comprehensive eye health examination. FIGURE REASON FOR PATIENT VISIT 45% 4 35% 3 25% 2 15% 5% 4 15% 12% 7% Question: Reason for Patient s Visit (Check all that apply) In 2015, the question regarding reason for patient s visit was altered to better reflect reporting trends. For historical data, please see Appendix A. Throughout Canada, CAO members are consistently reporting retinal holes, tears, or detachments and glaucoma as the ocular and systemic issues facing their patients most frequently. In 2015, the OIR question regarding Ocular conditions changed to reflect the severity of the patient s condition. This data provides detail into the how optometric care influences a patient s understanding of their overall health not just their eye health. March

10 FIGURE OCULAR/SYSTEMIC CONDITIONS DISCOVERED Treatable ocular condition; could cause permanent, irreversible vision loss Condition indicative of underlying systemic issues/disease Condition indicative of a potentially life threatening issue Retinal haemorrhage, neovascularization, traction, tumour, hole, tear or detachment 34% 2% Glaucoma, high suspicion of glaucoma, or presence of significant risk factors including occludable angles, pseudoexfoliation syndrome, 16% pigment dispersion syndrome Any form or combination of blepharitis, conjunctivitis, keratitis or episcleritis 5% Cataract 5% Dry Eye Syndrome, Sjorgen's Syndrome or other tear film disorders 4% Abnormalities in function/balance of the extraocular muscles 4% Macular Degeneration 2% Optic atrophy or neuropathy 2% 1% Visual field loss suggestive of retrobulbar/intracranial disease 2% 2% Diabetic retinopathy 1% 4% Hypertensive retinopathy 1% 1% Retinopathy associated with other systemic disease such as histoplasmosis, toxoplasmosis, Gardner Syndrome, pseudoxanthoma elasticum 1% etc. Central or Branch Retinal Arteriolar/Vein Occlusion 1% 2% Arteriolar embolus 1% Infection or occlusion of the nasolacrimal system 1% Anterior or Posterior Uveitis 1% Lesions of the eye and adnexa requiring excision or oncological assessment 1% Abnormalities in function of the facial muscles such as Bell's Palsy, myasthenia gravis 1% Internal ophthalmoplegia 1% Question: Ocular/systemic conditions or other issues discovered at this visit. (Select the severity of each condition identified.) March

11 In addition to the incident data submitted for the question The reported incident relates to the following conditions, some members provided written statements on their findings using the other field. Shown below, these other conditions were grouped by healthcare impacts. For longer text responses, please see Appendix A. FIGURE OCULAR/SYSTEMIC CONDITIONS REPORTED IN OTHER FIELD Conditions - reported as 'other' Count Lattice 6 Retinal hole 4 Nasal xanthelasma OU in upper lids; needed cholestrol checked 1 Choroidal melanoma - confirmed with retinal referral, IVFA and ultrasound. 1 Corneal ulcer 1 epi-retinal membrane / VM traction 1 Idiopathic Intracranial Hypertension 1 Krukenburg, c/d different between both eye 1 Macular edema/ hard exudate 1 End stage glaucoma LE, advanced glaucoma RE. 1 Referral to OMD for Nystagmus - now checking for MS 1 BRVO, retinal hemorrhage noted 1 Excessive movement and neovasc of cornea. 1 n=21, English and French responses, Optometry Incident Report 2015 Question: The reported incident relates to the following conditions OTHER response Given that the majority of the cases reported patients exhibit asymptomatic eye disease, early detection is crucial to treatment. However, 18% of patients wait more than 5 years between comprehensive eye examinations. An additional 35% of patients wait between 2 and 5 years between examinations. Together, these segments represent a significant portion of the population who are not aware of their eye health. Frequent eye examinations can identify issues before they become a significant burden to patients and the public healthcare system. Data relating to the frequency of patient visits should be used to garner support from national and regional healthcare organizations on the matter of eye examinations. March

12 Timeframe FIGURE 1.10 LENGTH OF TIME SINCE PATIENT S LAST EYE EXAMINATION HISTORIC VIEW First eye exam 8% 10+ years years 8% 2-5 years 35% 45% years 15% 27% 2014 Less than 1 year 2% 7% Less than 6 months 5% % incidents n=326, English and French responses, Optometry Incident Report 2014 Question: Length of time since patient s last eye examination According to the OIR data, far fewer patients confuse a sight test and an eye exam in Data from indicates that 31% of patients did not understand the difference between a sight test and a comprehensive eye examination; however, data in 2015 indicates that this number has dropped by half. March

13 % incidents FIGURE TYPE OF ASSESSMENT CONDUCTED 31% 12% 8% 9% 8% Patient did not understand difference btwn sight test & eye exam Independent Sight Test 66% 8 81% Comprehensive Eye Health Exam n=2,553 English and French responses, Optometry Incident Report n=326, English and French responses, Optometry Incident Report 2014 Question: The Patient s Last Eye Examination was Caution should be used in interpreting this data; since the sample size was significantly larger in , it is best to consider this issue under reported until a larger sample can be attained. March

14 % incidents A newly added question to the OIR addresses issues associated with patient lenses. 31% of patients who reported incidents experienced complications with their prescription lenses. 24% of patients experienced complications with their prescription eyeglasses, while of patients were related to complications with prescription contact lenses. Only 4% or incidents corresponded to over-the-counter eyeglasses or plano/cosmetic contact lenses. FIGURE TYPES OF CORRECTIVE LENSES USED % Prescription eyeglasses 1% 11% Over-the-counter eyeglasses 1 Prescription contact lenses 5% Plano/cosmetic contact lenses Complications No complications Type of corrective lenses Question: Types of corrective lenses used (Select the complication experienced with each type of lens.) March

15 % incidents 7 of incidents related to lens wear are associated with poor fit and incorrect prescriptions. 52% of respondents indicated that the complications related to lens wear, while 21% of respondents indicated that the patient s lenses did not match their prescription. The remaining 27% of lens related issues stemmed from handling and wear issues. FIGURE COMPLICATIONS WITH CORRECTIVE LENSES % % 12% 9% 6% Incorrect or poor fit Lense did not match prescription Contact lens wear complications Incorrect wearing regimen Improper handling Question: If the patient experienced complications with corrective lenses, indicate the source of the complication (Select all that apply) Source: 2015 Optometry Incident Report Form March

16 % incidents The 2015 OIR found that 4 of patients acquired lenses at an optical store, while 2 of patients acquired their lenses via a non-optical store, including discount, department and drug stores. 34% of patients acquired their lenses online. FIGURE PURCHASE LOCATION 5 45% 4 35% 3 25% 2 15% 5% 4 34% 2 Optical store Online Non-optical store Other Question: Identify the channel through which the patient acquired their corrective lenses (Select all that apply) Source: 2015 Optometry Incident Report Form March

17 Optometrist Findings From January to December , the Optometry Incident Report collected feedback from 192 members. During this collection period, 61% of patients visited an Optometrist as asymptomatic patients. On average, 4 of these patients booked an appointment with an Optometrist to update a prescription not to address a specific ocular condition. Given the high number of patients who exhibit asymptomatic eye disease, early detection is crucial to treatment. However, 18% of patients wait more than 5 years between comprehensive eye examinations. An additional 35% of patients wait between 2 and 5 years between examinations. Together, these segments represent a significant portion of the population who are not aware of their eye health. Data relating to the frequency of patient visits should be used to garner support from national and regional healthcare organizations on the matter of eye examinations. March

18 Appendix A FIGURE 2.1 PATIENT AGE Patient Age 47% 26% 16% 6% 2% n=2,553 English and French responses, Optometry Incident Report ; n=326, English and French responses, Optometry Incident Report 2014 n=85, English and French responses, Optometry Incident Report Q Question: Patient Age FIGURE 2.2 REASON FOR PATIENT VISIT Update prescription 55% 65% 79% Ongoing care of ocular health condition Eyestrain, headaches, double vision 7% 2% 12% 25% 16% Blurred vision 24% 27% 15% 3rd party report 2% March

19 n=2,553 English and French responses, Optometry Incident Report ; n=326, English and French responses, Optometry Incident Report 2014 n=85, English and French responses, Optometry Incident Report Q Question: Reason for Patient s Visit (Check all that apply) FIGURE 2.3 OCULAR/SYSTEMIC CONDITIONS Glaucoma Diabetic retinopathy Hypertensive retinopathy Retinal hole, tear or detachment Contact lens wear issues Amblyogenic refractive error 6% 6% 5% 6% 12% 12% 12% 11% 9% 15% 15% 18% 26% 29% Incorrect optical prescription Amblyopia Internal ophthalmoplegia Retrobulbar/intracranial disease 2% 2% 2% 2% 2% 6% 8% Macular degeneration Central Retinal Vein/Branch Retinal Arteriolar/Vein Occlusion Cataracts 5% 6% 8% 5% 15% 2 25% 3 35% n=2,553 English and French responses, Optometry Incident Report ; n=326, English and French responses, Optometry Incident Report 2014 n=85, English and French responses, Optometry Incident Report Q Question: Ocular/systemic conditions or other issues discovered at this visit. (Check all that apply) March

20 FIGURE OCULAR/SYSTEMIC CONDITIONS REPORTED IN OTHER FIELD LONG TEXT RESPONSES Saw patient at age 2. Had gone to another optometrist November 2013 and was prescribed glasses. Mom got glasses on line. Right eye 1.00 cylinder that is not there now vision is worse than 20/20. Blurred vision not correctable by an updated refractive correction (but also has previously undiagnosed glaucoma that was asymptomatic). Patient slept with cosmetic contact lenses dispensed from a gift shop in Montreal Red painful eyes secondary to wearing non-prescription costume contact lenses from a Halloween store Spectacles made wrong by Zenni optical, lenses were switched, were remade and patient wanted to ensure Rx was correct Spectacles made incorrectly by Zenni optical- online, wanted to ensure new spectacles were made correctly Patient purchased coloured contact lenses from local pharmacy - worn only 1 day and over night. MASSIVE corneal damage - central corneal adhesion and infection OU. Went from 20/20 in each eye at 2014 exam to OD 20/150 and OS 20/50. Patient purchased coloured contact lenses from local pharmacy - worn only 1 day and over night. MASSIVE corneal damage - central corneal adhesion and infection OU. Went from 20/20 in each eye at 2014 exam to OD 20/150 and OS 20/50. Patient purchased contact lenses online, last full eye exam 4.5 years ago; CL was never properly fit, resulted in infiltrates OU. March

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