Previous research into the accuracy of referrals for glaucoma has shown that a large number of referrals to the Hospital Eye Service are false positive. Research in areas of healthcare other than ophthalmology has shown that psychological distress can be caused by false positive referrals. The present study aimed to evaluate the quality of referrals to the HES for all ocular pathologies, and also to quantify the proportion of these referrals that were false positive. Any commonality between false positive referrals was investigated. The psychological effect of being referred to the HES was also evaluated using the Hospital Anxiety and Depression Scale (HADS) and State-Trait Anxiety Inventory (STAI). Both scales were validated in this population with Rasch analysis before use. A final aim was to develop an improvement to the present referral pathway in order to reduce numbers of false positive referrals. The accuracy of referrals to the HES appears to improve as clinicians become more experienced, and greater numbers of false positive referrals are generated by female clinicians. Optometrists refer patients with a wide range of ocular diseases and in most cases include both fundus observations and visual acuity measurements in their referrals. GPs mainly refer patients with anterior segment disorders, particularly lid lesions, based on direct observation and symptoms. Illegibility and missing clinical information reduce the quality of many optometric referrals. Patients referred to the HES experience raised levels of anxiety as measured by the STAI and raised levels of depression as measured by the HADS-Depression subscale. As a method of assessing psychological distress, the questionnaires HADS-T (all items), STAI-S (State subscale) and STAI-T (Trait subscale) show good discrimination between patients when administered to a population of new ophthalmic outpatients, despite all having a floor effect. Subsequently a referral refinement service was developed which reduced numbers of unnecessary referrals and reduced costs for the NHS.

Magister Pharmaceuticae - MPharm / The effects of disability on the individual not only include physical, psychological and emotional adjustments but also negative attitudes of able bodied people towards persons with disabilities. The attitudes of healthcare professionals towards persons with disabilities could affect rehabilitation outcomes as well as the reintegration of these people into society. The aim of the study was to investigate the attitudes of health science students towards persons with disabilities at Kilimanjaro Christian Medical Centre (KCMC), in Tanzania. An explorative quantitative research design using a cross-sectional survey was used. The study sample (182) included all Physiotherapy, Occupational Therapy, Nursing, Medical and Optometry students. Data was collected using the Attitudes Towards Disabled Persons Scale,consisting of 20 items rated on a six-point Likert Type Scale. A demographic questionnaire which included questions relating to the contact of the students with persons with disabilities was also administered. Descriptive and Inferential statistical analysis was conducted using the Statistical Package for the Social Sciences version 15.0. Permission to conduct the study was obtained from the Higher Degrees Committee and the Senate Research Grant and Study Leave Committee of the University of the Western Cape. Further permission was requested from Ministry of Education, Research and Ethics Department in Tanzania and the authorities of the respective Health Sciences programmes to include students in the study. Information obtained was handled with confidentiality and anonymity, and the students had the right to withdraw from the study at anytime.The results revealed that the sample consisted of more females (58%) than males (41.2%).The majority of the participants were between the ages of 20-29 years. The highest response rate was from the medical students (29.1%) followed by the physiotherapy students (27.5%).The Optometry and physiotherapy students had more positive attitudes than the rest of the health science students who participated. The mean score on the ATDP scale was 59.01 (12.3) with scores ranging from 18 to 90. The results therefore revealed that overall the students had a neutral to negative attitude towards persons with disabilities. With regards to the contact of the students with persons with disabilities 26.9% of the participants responded that they had had a long talk with a person with a disability while only 17.6% of the students responded that persons with disabilities visited their homes. The mean contact score was 22.72 indicating that the students had a slightly above average contact with persons with disabilities. No association was found between the attitude and contact mean scores.Information obtained in this study could be used to influence the curriculum of Health Science Students at Kilimanjaro Christian Medical Centre.

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Previous research into the accuracy of referrals for glaucoma has shown that a large number of referrals to the Hospital Eye Service are false positive. Research in areas of healthcare other than ophthalmology has shown that psychological distress can be caused by false positive referrals. The present study aimed to evaluate the quality of referrals to the HES for all ocular pathologies, and also to quantify the proportion of these referrals that were false positive. Any commonality between false positive referrals was investigated. The psychological effect of being referred to the HES was also evaluated using the Hospital Anxiety and Depression Scale (HADS) and State-Trait Anxiety Inventory (STAI). Both scales were validated in this population with Rasch analysis before use. A final aim was to develop an improvement to the present referral pathway in order to reduce numbers of false positive referrals. The accuracy of referrals to the HES appears to improve as clinicians become more experienced, and greater numbers of false positive referrals are generated by female clinicians. Optometrists refer patients with a wide range of ocular diseases and in most cases include both fundus observations and visual acuity measurements in their referrals. GPs mainly refer patients with anterior segment disorders, particularly lid lesions, based on direct observation and symptoms. Illegibility and missing clinical information reduce the quality of many optometric referrals. Patients referred to the HES experience raised levels of anxiety as measured by the STAI and raised levels of depression as measured by the HADS-Depression subscale. As a method of assessing psychological distress, the questionnaires HADS-T (all items), STAI-S (State subscale) and STAI-T (Trait subscale) show good discrimination between patients when administered to a population of new ophthalmic outpatients, despite all having a floor effect. Subsequently a referral refinement service was developed which reduced numbers of unnecessary referrals and reduced costs for the NHS.

Dizziness is a common, multifactorial problem that causes reductions in quality of life and is a major risk factor for falls, but the role of vision is a very under-researched area. This study aimed to investigate any link between dizziness and vision and to establish if changes in spectacle lens correction could elicit dizziness symptoms. A link between dizziness and self-reported poor vision was indicated in the epidemiological literature as shown by a systematic review, provided lightheadedness was not included in the definition of dizziness. Cases of individuals who reported vision-related dizziness were investigated to determine potential areas of research for this thesis and subsequently two studies investigated the effects of refractive correction changes on dizziness status. The first study was limited by logistical problems, although it highlighted limitations in the short form of the Dizziness Handicap Inventory that was used to quantify dizziness. Results of an optometry practice recheck study found that oblique cylindrical changes were significantly more likely to be associated with dizziness symptoms than other spectacle lens changes. It also highlighted that optometrists do not ask/record about dizziness symptoms with only 4% of records including “dizziness” as a problem when 38% of patients reported dizziness symptoms when directly asked. All studies highlighted a need for a patient-reported outcome measure to be designed to assess vision-related dizziness. Literature review, interviews with experts and patients and focus groups led to the development of a pilot questionnaire and subsequently a 25-item Vision-Related Dizziness instrument, the VRD-25. This was validated using responses from 223 respondents, with 79 participants completing the questionnaire a second time to provide test-retest data. Two subscales of VRD-12-frequency (VRD-12f) and VRD-13-severity (VRD-13s) were shown to be unidimensional and had good psychometric properties, convergent validity and test-retest repeatability. The VRD-25 is the only patient-reported outcome measure developed to date to assess vision related dizziness and will hopefully provide the platform to further grow this under-researched area that seems likely to provide important clinical information. / College of Optometrists sponsored the research with a Postgraduate Research Scholarship

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